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Saturday, January 28, 2012


"The federal government's Centers for Medicare and Medicaid Services is finalizing a new reimbursement plan ...Under the proposed rule, adherence to quality care measures will be weighted at 70 percent of the payment formula. Patient satisfaction surveys will account for the remaining 30 percent. "

Is this fair?

If the ratings are based on willingness to communicate rather then just walk in, essentially ignoring you as she does 2, 3 other things (I had a doc who was on the phone the whole time he was supposedly listening to me and why I was there.) that is a good idea.

If it is based on knowing you and your history (if a first time visit, actually examining you, not just a cursory listen to your lungs and heart.) that is a good variable.

Does the doc have the ability to empathize? Does she actually "get" what you tell her, does she understand the level of pain you are in? Does she believe you? If she doesn't is she honest enough to say "I cannot help you." and offer to find a doctor who might?

Does she see you not as a patient but as potential criminal, malingerer, drug abuser? Is her attitude one of working with you or against you (your pain isn't real, it is not as bad as you say, etc.)?

Does she see you as money in her account? She has not been able to help you but continues to insist you come back, again and again, holding out the hope of 'the next visit' will be the one where she has the idea that will help you?

When I googled 'medicare payment tied to patient satisfaction' I came across an article written by a doctor. He wrote that he did not think it was a good idea because it will result in giving patients whast they want rather then what they need.

A site for student doctors agreed with that. Most cast patients as stupid, people who would give them a good rating only if they started "recommending Big Macs and Hot fudge Sundaes to everyone." ("

One other big complaint: patients would want opiods and rate the doc bad if they did not get them. Chronic pain and chronic pain patients seemed to get the most ire from these docs and students.

I have stayed with docs who were awful and I have had docs that I wish had not retired or moved, docs I would literally lay down in the street for and say "Go ahead." to whatever they suggest.

Should those good docs get paid more? They had good communication skills, empathy, decency. I have also had awful docs who had these skills. And a few, very few, docs who would score very low on these qualities but high on the 'helped me' scale.

What are the qualities that make a doc good, that cause his patients to give him a good rating?

If he has these qualities and if I paid him out of my own pocket would I be willing to pay him more?

It is definitely a question worthy of discussion.


  1. I agree with virtually all said above. What is missing from all the discussions I have seen is a more sinister side that does not involve the patients directly: The practice of regulations and insurance companies financially penalizing doctors because they "don't like" what the doctor is doing....without regards to the impact on the patient. Believe me, there are financial penalties, huge ones, for very rare doctors who specialize in treating and managing patients with chronic intractable pain!

    Bottom line: We need a medical care reimbursement system that rewards doctors for good quality work, but one inwhic the PATIENT is a vital team member and not the raw material or poker chip in the game of doctor-insurance production line or poker game!

    1. id say bedside manner rates up there... i had terrible bedside manner once when i was in japan... though i think that was due to the language barrier... X_X

    2. Does make it harder, although medical language speaking docs can be just as bad (:

    3. Anonymous, you make a good point. At least with this medicare/medicaid proposal we know what the criteria is for docs getting psid. We really don;t know why non gov't makes the decisions they do.
      (I was just refused insurance because of my stimulator (considered pre existing) When I tried to find out why the woman who made the decion, their underwriter, hung up on me.