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    Superior pay for non-performance model threatens dermatology, society

    Economies of scale affect payment strategies

    Zoe Diana Draelos, M.D.Zoe Diana Draelos, M.D.What would happen to society if people were paid more for doing less? Would people work harder and harder to get paid less or do less and less to get paid more? I think this question demands a large, properly powered, cross-sectional, multivariate, multi-generational, prospective, case-controlled study. This is a very important study because we are instituting superior pay for non-performance as the new model for many segments of our society, including medical care. Dermatology is at the forefront of the superior pay for non-performance medical experiment, as we are fortunate to take care of a resilient organ that is rapidly renewing and easily accessible for treatment, thus minimal treatment or lack of treatment can be tolerated for a longer duration without increased mortality. (Remember that reduced morbidity as has no role in the pay for non-performance model.)

    In my community, the battle for insured lives is heating up fast. The local hospital, which went bankrupt, is owned by the University of North Carolina at Chapel Hill Healthcare System, also known as the Tarheels, while the large multispecialty community physician group, that also went bankrupt, is now owned by Wake Forest University Healthcare System, also known as the Demon Deacons. For those of you who are basketball fans, we now have a NCAA Final Four rematch between two powerhouse ACC teams. Who will win? Stay tuned. The battle will be won by the institution that is able to charge the most money to insure the largest number of lives for the least expense, thereby instituting a successful accountable care organization (ACO). This goal can only be achieved by strict adherence to the pay for non-performance model.

    More from Dr. Draelos about insurance: Shrinking insurance formulary limits Rx options

    Next: Economies of scale

     

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    Zoe Diana Draelos, M.D.
    Zoe Diana Draelos, M.D., is a consulting professor of dermatology, Duke University School of Medicine, Durham, N.C. She is investigator, ...

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