Not very long ago the scarificator (shown above) was considered at the height of technology. With this device, it was easier to produce the healing effects that were widely known to come from blood-letting. Had there been health insurance companies at the time, I presume there would have been an acceptable billing and procedure code for the application of this device. Were there any studies to show the efficacy of this? None that I have seen. Yet, I suspect that we would still expect, unwitting insurance companies to send a check in the mail.

While this may be an extreme comparison, it is still a valid one. Why should we expect insurance companies (or any payer, for that matter) to simply hand us (providers) a check after “services rendered” with no question as to the quality or necessity of that service. Now, you can certainly question the validity or practicality or usefulness of our current health insurance system. However, I would expect nothing less than for someone (whether an individual or a business) to want to know what and of what quality a service they are receiving prior to paying for it.

Unfortunately, we have been in the era of fee for service for quite some time now. This is all we know. Change is hard and usually (so we think) bad for us. So, we have to push back against the change to pay for performance or for quality or some derivation thereof. Now, I am not saying that the ultimate outcome of this transition will not produce financial pain. Nor, am I saying that the final product will be perfect or even better than the system we have today. However, I am saying that there will be a new system. We can either try to shape that new system in a way that is good for our patients, ourselves and our society; or, we can sit on the sidelines and root for a lost cause.