Video review: How Doctors Get Paid : KhanAcademy

I found this KhanAcademy video linked from the (excellent) Thedacare Center for Healthcare Value blog

Unfortunately, I don’t think this video is that excellent.

Partially because of the format, partially because Salman Khan seems a bit impatient in the narrative to draw conclusions. The narrative is given by Laurence Baker from Stanford who does a credible job of trying to keep things focused.

They glossed over the quality and prevention focus differences between salaried physicians and the other two payment methodologies, which is huge. It might have been easiest to say, “In fee for service you get paid to do more things to people, in a salaried situation you get paid to do the right things for people.” or “You make money when patients are sick in fee for service, you make money when people are well in salaried practices.” They missed this nuance altogether.

I think they were a bit charitable when they say that fee for service arrangements don’t weigh on physicians’ treatment recommendations. If you just look on the comments on the YouTube video itself you can understand that this isn’t the case. There are several comments about patient churn and multiple unnecessary test ordering in fee for service practices.

In any event, perhaps a good conversation starter so people can ask better questions? See for yourself. It would be great if there were a follow-up video that looked at the impact on the health of people of these payment systems, which is really what matters most….

Ted Eytan, MD