Fee For Service Or Fee For Outcome? Lessons From The Injured Athlete

Here's a question to anyone who has ever been a patient in the health care world: Are you paying for a service, or for an outcome?

And to all of you clinicians out there, I ask a similar question: Are you charging for a service, for your time, or for an outcome?

I would suggest that patients seek out the guidance of clinicians to attain an outcome.They are searching for a game plan to provide a tangible outcome of some form or another. That tangible outcome may have multiple steps, but it is still a specific outcome.

If there is a patient population that demands an outcome - and promptly - it is the athletic population. It becomes even more important to those athletes who make their living from sport. Health care in general stands to learn a lot from the ways of the injured athlete.

There is an intriguing conundrum in the traditional health care model. It doesn't matter if you are in a fee for service clinic or one that accepts payment from third party payers, the incentives are still inherently wrong. The more visits, the greater the clinician's income. There is no element of clinician accountability - log in your time (or units) and get reimbursed. Simple.

Would this be acceptable to a high level athlete who's career is dependent upon his or her ability to be on the field? No. The cost of care wouldn't necessarily be the problem. Professional teams will certainly look after their prized assets. But the outcome becomes far more critical. The clinician that guides the athlete's prompt return to the court or field the fastest is the clinician making the best salary. An athlete - or their team - doesn't want to waste a lot of time and countless visits on a clinician who just is simply logging in time or billable units. Expectations are high, and satisfaction is critical.

If you are a clinician, it is survival of the fittest, and rightfully so.

The sporting world is pretty simple: show me the outcome. It is a team issue, and a rather important career matter for the athlete in question.

So why should this perspective change when you are the sedentary office worker with back pain or the weekend runner with shin pain? Are they not driven by outcome as well? Of course they are. It is just defined a little differently by the patient.

Patients come to us seeking an outcome, oftentimes related to their inability to perform a task or activity without pain. The goal should be to provide high patient perceived value and self-reported functional outcome, and do so in fewer visits - just like the sports world demands of us. Reimbursement should reflect this, with incentives being built in to promote excellence and not mediocrity - again, just like the sports world demands. 

As a clinician, do you have the confidence to provide a fee for outcome service? Are you prepared to be fully accountable for your outcome and not just your time?

We do it for athletes. Why not everyone else?

Photo credits: M I K E M O R R I S

Related Articles By Allan Besselink

• The Disconnect Between Patients, Insurance, Incentives, And Cash
• Misguided Incentives And Profound Mediocrity Guide Today's Health Care
• Clinician Accountability And The Health Care Reimbursement Game