• Should physicians have an Amazon.com-like check out?

    In Do Physicians Need a “Shopping Cart” for Health Care Services? (JAMA), Robert Brook asks,

    What if every time a practitioner used an electronic medical record system to order a procedure or test for a patient, an electronic shopping cart appeared, indicating how much that “purchase” would cost? What if at the end of the day the practitioner received a statement indicating precisely how much money he or she had ordered to be spent on behalf of patients? What would happen? Would anybody care?

    Well, if the practitioner were employed by an ACO or operating under a capitated arrangement with an insurer, his or her organization would certainly care. In that case, likely incentives would be put in place to translate that motivation to the point of delivery. So, if we want clinicians to care about cost, if we think they should care about cost, we can try to arrange the system so they will by putting them and their organization at risk for that cost. In fact, that seems to be the wave of the future, both for public insurance programs and private plans. (Well, it’s one wave, anyway.)


    • In addition to costs, an Amazon-type system would also provide outcome and satisfaction data. “Other patients like you have also considered the following treatments withe following outcomes – and costs.”. This would be useful.

    • Put the MD and his organization at risk for that cost???

      The only reason most MDs do so many tests and procedures is due to the liability to themselves and their organization for missing something. It is a lot like terrorism. You only have to miss one and you have a big problem. The american public demands perfection so they get to pay for perfection. ‘
      Single payer system: treatment spelled out. More treatment? Two MD consult… MDs have to be protected from missing something. Otherwise they order the tests.
      I can’t tell you the last time I say a Positive Lumbar Puncture!!