Blog | Monday, September 23, 2019

Should doctors offer a money back guarantee?


It may seem odd that a gastroenterologist patronizes fast food establishments several times each week. I'm in one right now as I write this. I eschew the food items, though French fries will forever tempt me, and opt for a large sized beverage. In truth, I am not primarily there for a thirst quenching experience, but more to ‘rent a table’ so I can bury myself in some reading. Indeed, many thousands of New York Times issues have been devoured at these tables. I saw a sign posted on the wall here that I had not seen before: “Sorry, No Refunds”.

Refunds? How often can this happen in a place like this? We all know that food items in these institutions are remarkably consistent, which is one of benefits that customers enjoy. Your Big Mac or Whopper will taste the same in Pittsburgh as it does in Peoria. I questioned the server on this new development and she explained that increasingly customers were demanding refunds for contrived reasons in an effort to bilk the restaurant. At some point, the restaurant decided to put an end to this practice.

I wonder how my patients would react to being greeted by such a sign in my office? Of course, physicians do not offer refunds or a money back guarantee for our services, as other industries boast. Nearly every infomercial includes the tag, ”and if you don't agree that these _____ are the best you've ever used, simply return it for a full refund – no questions asked!” Not so in the medical profession. We are paid regardless of the outcome or your satisfaction.

It is true that physician reimbursement policy is evolving away from fee-for-service (FFS) toward a value-based system. In other words, physicians won't be paid separately for every medical service we provide you, but for the overall “value” we provide, which is a somewhat amorphous concept. FFS clearly incentivizes the medical profession to overtreat patients because we are paid more for doing more, even if such care may not be truly necessary. It remains to be seen if the value-based payment approach will protect patients and be fair to physicians. I have my doubts.

Many professionals are paid regardless of how their clients fare. It you lose your case in court, your lawyer will still be paid. If a judge is overruled on appeal, his wages aren't reduced. If your investment underperforms, your financial planner doesn't return his fee to you. Tradesmen, on the other hand, make a commitment to satisfy us as a condition for getting paid. If we hire a plumber to unclog a sink, for example, he understands that if he doesn't deliver, then we won't either.

What if all of us were paid on results rather than on time expended? Would this lead to higher quality goods and services? Could it really apply to the medical profession? If a patient comes to see me with abdominal pain, which often defies explanation even after a thorough medical evaluation, is it fair that I wouldn't be paid if the patient's pain persists?

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This post by Michael Kirsch, MD, FACP, appeared at MD Whistleblower. Dr. Kirsch is a full time practicing physician and writer who addresses the joys and challenges of medical practice, including controversies in the doctor-patient relationship, medical ethics and measuring medical quality. When he's not writing, he's performing colonoscopies.