On July 9 the Tribune ran a balanced and thoughtful news article regarding the decision of the Health Care Financing Administration (HCFA) to postpone putting into effect regulations requiring disclosure of physician financial incentives for Medicare and Medicaid risk-based health benefit plans. These rules prohibit plans from establishing specific payments or incentives that could result in limiting care to patients.
As reported by the Tribune, the AMA was disappointed that there will be a delay in implementing these rules. We commented to HCFA that these rules were a good first start, and we asked to have significant financial incentives regarding physician payment disclosed to patients without requiring them to ask for this information first.
In a July 21 editorial, you characterized this issue as merely a battle over doctor pay between managed care and fee-for-service delivery systems. We think you have vastly oversimplified a very important concern that goes to the very heart of quality patient care.
This is not a fight over pay. These disclosure rules and the actions surrounding them are fundamental patient protections, in this case protection for tens of millions of elderly, poor and disabled patients who have a right to know how their doctors are paid. Until we know more about how the market will respond to powerful financial incentives, patients need to be protected. We worry that sometimes these incentives may work too well and provide unanticipated results.
Medicine is a shifting and rapidly moving field; reliable measures of quality are not yet in place. When dealing with the elderly and poor, we should err on the side of caution. This is more than a simple fight over pay, and the Tribune has done more harm than good by trivializing a matter that has already been debated and decided by Congress and the American people.
