Annals of Health Law
VALUE BASED PURCHASING
question of whether the Program and the Initiative will make a meaningful
difference without shifting how we treat health problems. Of course, this
also raises the question of the role of prevention and amelioration of
behavior driven illness, such as obesity and diabetes. Solving these will
require significant resources.
F. Providing Care That Will be More Cost Effective
Both the Program and the Initiative plan to reduce costs by changing how
health care services are reimbursed, seemingly in hopes that in addition to
reducing payment, an indirect result will be that providers will alter their
behavior to reduce the use of unnecessarily expensive services as a personal
measure to increase their profits. However, both the Program and the
Initiative ignore the fact that providers are self-interested in providing
services that will yield them a profit. A prime example of how this self-
interest increases cost is the higher reimbursement rates for specialist
physicians as compared to primary care physicians. 155 Often, specialist
physicians will provide services or procedures within the scope of practice
of a provider who could be reimbursed at a lower rate. 156
155. See generally the CPT Code to compare reimbursement rate for primary care visits
versus procedures performed by specialists and surgeons.
157. See R.F. Caitlin, et al., Primary Care Gatekeepers in HMO, J. OF FAMILY
PRACTICE, 673, 673-78 (1983).
158. See 42 U.S. C. § 300(e) (1996).
159. See MARKCRANE&LESLIEKANE,MA,MEDSCAPEPHYSICIANCOMPENSATION
REPORT 2011, http://www.medscape.com/features/slideshow/compensation/2011/.