Is a pay increase on tap for primary care docs? Big Tech’s crises send talent to health startups, and more top health care news

The federal government is testing a new primary care project that will pay physicians for improving patient outcomes—and not by the number of services or tests he or she orders.

The program, launched by the Centers for Medicare & Medicaid Services, has five different payment models. One CMS official told Stat that performance-based payments could increase doctors’ salaries by as much as 50 percent — meaning doctors who make $200,000 today could see their salaries increase to $300,000 if they are able to keep their patients healthier and out of hospital emergency rooms.

“This is probably the best proposed initiative for primary care payment that has come out of CMS,” Dr. Allan Goroll, a Massachusetts General Hospital physician and primary care expert, told me this week.  

Still, Goroll cautions that the program’s success will hinge on a number of unknown factors, such as how much control a primary care doctor gets over a patient referral to a costly specialist. In the current model, a patient heads to the PCP for a referral to a specialist. In a value-based reimbursement model, specialists should have to participate in some of the same financial risks and rewards as PCPs, or the primary care doctors should be allowed to order some of these tests, he added.

In recent years, there have been stronger efforts to figure out how to better incentivize new doctors to stick with primary care, one of the lowest paid medical specialties. One idea to gain traction lately is to provide free or discounted medical school tuition.

“This certainly helps attracting the best and brightest to come into primary care,” Goroll said. “We need them desperately.”

What’s your take on changing the way primary care services are paid for? Do you think a new CMS initiative has the potential to improve the U.S.’s primary care system?

News I’m Watching

1. ‘Cards’ comment about nurses turns into teaching moment about shift work. A Washington lawmaker apologized this week for saying that nurses don’t need breaks because they play cards for part of the day. The comments were made as the state considers legislation that would require that nurses get uninterrupted meal and rest breaks. Nurses began calling for the lawmaker to shadow a nurse on a 12-hour shift to understand what their days look like.

“Nurses work hard. Most of the time we graze throughout our shift because we put patient care before our own. Until you walk in the shoes as a nurse, or in any profession or way of life, try and be part of the solution, not the problem.” - Jill Batrous, emergency room nurse

2. Does a culture of overtreatment begin in medical training? That’s what some physicians believe, according to NPR. A 2014 study examining costs from high-spending regions found that physicians who were trained in those regions were more likely to perform more tests and procedures. One way to combat overuse of medical procedures is to compare one doctor’s performance to their peers. "The best way to avoid a diagnostic error is to avoid an unnecessary test," radiologist Dr. Pamela Johnson told NPR fellow Dr. Mara Gordon.

“You can alter our training all you want but when you finish your residency, you are thrust into a world where you only get paid if you do something.” - Dr. Jason Lockette, president at Integrity Family Care

3. Let down by scandals, tech talent now considering jobs in health care. A series of morale-lowering issues at companies like Alphabet and Facebook has made it easier for health care and education startups to recruit top tech talent, according to CNBC. Genetics company Color Genomics, for example, has reportedly seen more interest from engineers, designers and product managers who previously worked or currently work at large tech giants. A 2018 LinkedIn survey of early career doctors and pharmacists found that impact of the work was one of the top reasons they wanted to work in tech.

“I would be curious to know how much age/experience may play into the shift. It's possible even without scandals some employees would be leaving to do something they found more meaningful.” - Nadia Alvarado, communications program manager, Sutter Health

What’s your take on this week’s stories? Does this CMS program have the potential to improve primary care? Should nurses share more about their workdays look like? Does ordering too many tests begin in medical training? Will more tech workers move in health care now? Share your thoughts in the comments, using #TheCheckup.