Where will incentive disclosure end?
Regarding "Doctors have no legal duty to disclose incentives: AMA brief" (Article, March 20): Kudos to the AMA for opposing the legal obligation to disclose financial incentives. What is next? Do we need to disclose incentives to our fee-for-service patients?
Should we tell them that if we have more complications, longer hospitalizations, and perform more operations on them, that we get more money?
We would all like to be better paid, but we became physicians for a different reason. At graduation from medical school we took an oath that included: "In every house where I come I will enter only for the good of my patients, keeping myself far from all intentional ill-doing and all seduction."
Has everyone but the physicians forgotten that?
--Howard M. Landa, MD
Loma Linda, Calif.
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Patients should know how contracts affect care and physicians should be the ones to tell them
Financial disincentives are an obstacle to any balanced and ethical treatment.
They should not be in contracts to begin with.
Clearly patients should have all the information they need to know how their physician is making decisions about their medical care. Someone should inform the patient. Why not the physician, who, by his or her commitment to the care of the patient, has the best human relationship with the patient?
You can hardly expect insurers to tell their prospective purchasers of health care that they have built into their health care contracts incentives to second-rate and limited care. That would be like a manufacturer trying to sell an item based on its defects.
Who else but the physician should have the best interests of the patient centermost?
The physician can also choose to not order a procedure based on best medical evaluation and not just because there is a financial disincentive involved.
There is no reason why patients should not know the cost of their medical care. Perhaps if our patients understand the cost of medical care, they will become better informed about how to manage their medical care as opposed to having it managed for them.
--Chester M. Berschling, MD
Pittsburgh
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To cut prescription errors, drugs should have a name and a number
I am writing this to express a possible solution to the difficulty that different people have with doctors' handwriting on prescriptions. I suggest that we could possibly assign and attach a specific number to each medication. Then the pharmacist would have both a name and number for each medicine and dosage size.
I think that certainly this could be accomplished in the computer age that we live in.
--Jack Kayes, MD
Clayton, MO.
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Letter criticizing PAs was"alarming and inflammatory"
I read the letter by American Academy of Physician Assistants President William C. Kohlhepp, PA, "PAs are not seeking to take over role of physicians in patient care"
(Letters, March 20). I then read a letter, in the same issue, written by Hil Rizvi, MD, "Care compromised by PA sites only remotely supervised by physicians."
(Letters, March 20).
Dr. Rizvi's letter is both alarming and inflammatory. To take the position that because of a shortened medical education, PAs would provide substandard and potentially dangerous care, shows that his argument is coming from misinformation.
Countless studies have shown that we provide excellent health care equal to that of our employing physicians, enjoy patient acceptance and loyalty, enable patients in medically underserved areas to access care and, yes, bring in a considerable income.
In the medical profession there are those who, with twice the years spent learning medicine, offer half the quality of care. A degree does not necessarily confer competence.
We continue to learn on a daily basis, and experience will, in every instance, provide a learning environment equal to or better than the classroom.
I provide quality, community-standard health care to my patients and have been doing so for 25 years. My employing physician would not allow me to see patients if my abilities were in question. My patients would not continue to insist on seeing me if they were not getting well.
--Charles Cusumano, PA
Campbellsville, KY.
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Long overdue paycheck makes Medicare claims sound hollow
Regarding "Clinton budget boosts efforts to combat Medicare fraud"
(Article, Feb. 21): This article contains a quote from Health and Human Services Secretary Donna Shalala, PhD: "We have dramatically cut overpayments, and we are now demanding that our costs reflect market realities." I think that it would be very difficult for most practicing physicians to ever indicate when they have been overpaid by Medicare.
Just recently I received a check that represented my monthly salary 17 months ago. It hardly seems that there have been overpayments to physicians when one's income is behind by almost 1½ years.
--James P. Ahstrom Jr., MD
Downers Grove, Ill.
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