Dr Vineet Arora: Balancing Reimbursement Incentives With What Matters to Clinicians

Our current health care reimbursement system rewards procedures and undervalues the time spent talking with patients and learning their history, which speaks to the need for primary care redesign, according to Vineet Arora, MD, MAPP, dean for medical education at UChicago Medicine. This interview was conducted ahead of the 2022 Patient-Centered Oncology Care® meeting, at which Ishani Ganguli, MD, MPH, received the Seema S. Sonnad Emerging Leader in Managed Care Research Award.

Transcript

Is it possible to reconcile the tension between what’s rewarded in the health care payment system and the principles that physicians actually value?

Oh, wow, that's a tough question. But yes, I did say that—a lot of people talk about how we've got to measure what matters, right. I mean, that's sort of very germane to your group of attendees at this conference. I think that we also have to pay for what matters in clinical care. And, unfortunately, the [relative value unit]–based system that we have for clinical care, especially for payment of clinicians, rewards procedures and overmedicalization, right, and it undervalues talking to patients.

I was just on service, and I’m struck by how, even we say this in medical school, so much of it is getting a good history. We don’t pay people to get good histories, and as a result, we have short visits, we don’t get good information. If we just had time to really have those productive, trusted relationships with our patients, we might be able to get the right information that would lead to the right test ordering, as opposed to the shotgun approach that sometimes occurs because you’re like, “I have to move on to the next patient and time is ticking.”

I think this visit-based approach, where it rewards procedures at the expense of undervaluing the visit of actually taking a good history, is challenging. I do know procedures are very complex, and they deserve payment, but I do think there’s got to be something to be said for good primary care. And we know that countries that have good primary care and reward primary care have not just better outcomes, they have lower costs, and those are both things that we need in the United States. So, I would say we need to think about strategic investments in primary care and primary care redesign, which of course I know that many people are working on here as well as Dr Ganguli.