How doctors actually get paid more for writing more statin prescriptions - Shanahan

How doctors actually get paid more for writing more statin prescriptions Statin Payments

Catherine Shanahan


You may have read that doctors receive payment or bonuses for prescribing statins, the cholesterol-lowering drugs. I'm a chapter leader in Kauai, and a family physician, so I'm in a good position to fill in some details about how doctors actually get paid more for writing more statin prescriptions. The mechanism is a little cumbersome to describe clearly, but I'll take a stab at it.We have a series of "quality measures" that are tracked by the insurance company. One quality measure is the number of mammograms we do on our patients between ages 40 and 69, another is that we send our diabetic patients to the eye doctor once a year for retinal exams. For our patients who carry a diagnosis of "coronary artery disease," we have to write them a prescription for a cholesterol-lowering drug. If any one doctor doesn't follow any one of these imperatives, he loses points toward a cash bonus, and the entire group is similarly penalized. As you can imagine, there is lots of peer pressure to prescribe!

Actually, we don't get our bonus unless the patient goes and buys the drug or gets the test or sees the eye doctor and so on, so it's not enough just to write the prescription, we have to talk up the drug enough to get them to go out and buy it. Currently, there are only a few means by which a person can be labeled as a patient with coronary artery disease. Having a heart attack is one, and having abnormal results on heart tests (like angiograms) is another. Diabetes is now considered a "coronary artery disease equivalent" and so, in the near future, doctors may be required to get all our patients who have type one or type two diabetes to take their statins, or lose more money.

These HMOs are insurance companies like Blue Cross, which offer their clients (employers and patients) HMO programs. The HMO plan we have is offered by HMSA (Hawaii Medical Something Something). For whatever reason, HMSA wants to offer an HMO program for people, and doctors who participate as providers must comply with the rules of the program and accept payments according to the rules. There are clear benefits to pharmaceutical companies in this structure but no obvious reason why HMSA would want to encourage people to buy expensive drugs that HMSA must pay for. One might speculate that there are some quid-pro-quo relationships between the insurance companies and the pharmaceutical companies, but I have no idea what they are. However the ties are structured, I feel, as do many other scientists, that these kinds of business relationships lead to behaviors that pose real threats to patient care, and to human health in general. Because industrial connections like this fund most research, they distort the scientific process and are far more insidious, invisible, and totalitarianistic than expensive dinners and trips to Hawaii, which are what the media would have us believe is the sum total of the problem.

By the way, the bonus is actually not a bonus at all. This is where it gets Orwellian. We give up a certain percentage of the payment for accepting HMO patients, and we get it all back, in theory, if we meet all of our quality measures. We never do because of computer glitches which continually fail to track our prescribing, testing, and referring patterns accurately. Nobody can explain why we've agreed to accept HMO insurance plans, but we seem to feel we have no choice. And we will have less choice before long; Medicare is planning to begin similar programs. Each of these programs takes more money away from the doctors and gives it to middle managers, ensures that drug companies get more money, and that expensive tests of limited value are done more often.

These are some reasons why savvy business people are going into "alternative" medicine where they benefit from cash payments and total autonomy. Several here on Kauai are making millions.

Catherine Shanahan MD

Kalaheo, Hawaii

This article can be accessed at: http://www.westonaprice.org/letters/754-letters-winter-2006?qh=YTozOntpOjA7czo5OiJjYXRoZXJpbmUiO2k6MTtzOjg6InNoYW5haGFuIjtpOjI7czoxODoiY2F0aGVyaW5lIHNoYW5haGFuIjt9

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