Environmental forces that affect physician behavior

Environmental forces can inhibit and undermine physicians’ ability to fulfill their obligations to their patients.  After careful analysis, advocacy can help address the gaps and perverse incentives in these systems.

Payment policy

Current payment methodologies undermine physicians’ abilities to adhere to professional values.

Health care services are compensated at different levels, and physicians in theory are expected to provide equitable care to all patients, yet there is a strong incentive for physicians to prefer those who are reimbursed more favorably, which can lead to disparities in care.

For example, fee-for-service encourages physicians to provide more care for more reimbursements.

Possibilities for reform:

1) Remove as many services as possible from fee-for-service and re-pricing remaining services to eliminate disparities in relative profitability of services

2) Replace individual physician payment with payment to larger units of accountability that utilize evidence-based guidelines and promote professionalism.

3) Funding a “primary care stimulus package” to quickly re-infuse primary care services into the system.

Organizational strategies

A renewed focus on mission and culture change, in conjunction with an electronic health record and a robust performance measurement system are key drivers in the organization culture to support professionalism.

Physician organizations and delivery systems are encouraged to provide feedback to physicians on their performance and make explicit investments in improving care for disadvantaged populations.

Public reporting

Physicians are encouraged to embrace public reporting as a fundamental act of professionalism that supports continuous quality improvement in practice. Yet it is difficult to find the right balance between what information consumers and physicians want and need to drive improvement.  Click here to see ABIM’s article. [1]