Atul Gawande, Piecework

Atul Gawande, Piecework - Atul Gawande, “Piecework” I....

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Atul Gawande, “Piecework” I. Standardized fee schedule-pay physicians according to the “usual, customary and reasonable” fees A. In mid 1980s, doctors who spent an hour making a complex & lifesaving diagnosis were paid forty bucks, for doing a colonoscopy and excising a polyp, more than $6,000 1. In 1985, feds decided payments ought to “be commensurate w/ amount of work involved” B. 1985—William Hsiao, Harvard economist-began to measure exact work involved in each task doctors perform 1. Work was a function of i. time spent ii. mental effort 2. Determined that hysterectomy takes 2x as much as time as a typical session of psychotherapy, 4.47x times as much technical skill and physical effort and 4.24x as much risk 3. Congress set a multiplier to convert values into dollar & by 1992 Medicare paid accordingly Misc fact: insurers find a reason to reject up to 30% of bills they receive (Gawande) II. How specialists must deal with patients
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This note was uploaded on 05/27/2008 for the course CH 2 taught by Professor Mckissick during the Spring '07 term at Tufts.

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Atul Gawande, Piecework - Atul Gawande, “Piecework” I....

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