What if we were included in the Affordable Care Act?

            Much has been said in the last week about the Supreme Court’s ruling on the Affordable Care Act.  Some of my more conservative friends have jokingly asked if this law includes pets as well.  Though there would definitely be some aspects of the law that would lead to a gigantic boom for the veterinary industry (suddenly seeing and getting paid for the two thirds of household pets that currently do not seek veterinary care) and other aspects that would be frustrating to deal with (the bureaucratic stipulations for when certain diagnostics can be performed) the one aspect of the law that I find intriguing is tying doctor compensation to performance. 

            We share a similar model of production to medical doctors in that we are paid on how many vaccines we give, how many serum chemistries are run and abdominal exploratory surgeries are done.  In the Affordable Care Act there are attempts to link doctor’s pay with the outcomes of their medicine.  Right now if I do a splenectomy I get paid a percentage for that surgery no matter the outcome.  In fact, if there are complications such as internal bleeding that requires a blood transfusion, more bloodwork monitoring and further hospilization stay then the bill is higher and thus my compensation is greater.  But what if there was a system in which I would be compensated more if that splenectomy went uneventfully and the patient walked out the door the next day?  There are many situations when we do our absolute best; the costs to the client are less, and thus less production to the hospital and doctor as well.  Should those situations be rewarded with more compensation?

            One could easily argue, ‘Andy just like snowflakes no two splenectomies are alike.  You probably did your absolute best in both situations, but due to each situation the outcomes were different no matter what you as a quality doctor did.  There are complications such as metastasis, clotting disorders and gross anatomical changes that are going to change the surgical time, aftercare and prognosis.’  It would be difficult for the medical director or hospital manager, let alone someone as far away asWashingtonD.C.orPortlandto determine when a doctor should be rewarded for the best possible outcome, as compared to when the outcome was not ideal but was a result of the given circumstances and not related to the doctor’s care. 

            A key facet to the Affordable Care Act is trying to compensate doctors with a flat salary and not on production.  There has been a parallel trend in veterinary medicine to pay doctors based on production.  This model has been shown to be more profitable for both associates and owners alike.  Does this model produce a better quality of medicine?  Does production based compensation encourage a doctor to perform more diagnostics and make more recommendations for the best interest of the pet?  Or does a production based method induce a doctor to make unnecessary recommendations that drive up pet owner’s bills?  There are many compelling arguments and individual cases that could make both arguments.  The bottom line is that our niche of medicine is not considered to be a ballooning cost that will one day be insurmountable.  There is no immense federal program coming along that will dictate practice of medicine or decide if compensation should be based on production or a set salary.  These are decisions for our industry to make on its own, for each practice and each individual doctor.  It would be nice at times to have a huge safety net, but usually free will wins the day.  Can I get a 9-0 vote on that?

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