Doctors' Dilemma: Lower Costs, Please Patients, or Avoid Lawsuits?

Leigh Page, MS


September 11, 2014

In This Article

Doctors Are Pulled in Opposite Directions

Growing pressures to keep healthcare spending in check are forcing physicians to go up against patients demanding unnecessary services, plaintiffs' attorneys looking for allegedly "negligent" care, and hospitals that encourage employed physicians to bring in more revenue.

Pressures to reduce spending are intensifying along with the growth of new forms of care such as accountable care organizations (ACOs), bundled payments, and new versions of capitation.

New cost-saving pressures are also increasingly affecting the medical profession. These voluntary programs include a push for price transparency, more access to and reliance on clinical guidelines, and the Choosing Wisely® campaign to eliminate unnecessary or less useful tests and procedures.

Powerful forces, however, stand in the way of these changes. Many patients demand unnecessary services, such as antibiotics for sore throats. And when doctors cut out tests like MRI for nonspecified back pain, they are not protected from the risk of a malpractice suit for not ordering them.

As these contradictory forces take hold, "doctors are increasingly in a tough spot," says Bruce Boissonnault, president of the Niagara Health Quality Coalition in Amherst, New York. Boissonnault, who develops quality measures for healthcare, identified yet another way that physicians' best efforts to control costs can be undone: Some hospitals pressure employed physicians to order more services from the institution. "Along with the pressure to cut costs, there is the pressure to generate revenue," he said.


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