Medical Malpractice

How would bundling payment in health industry give hospitals more power and doctors less autonomy?

I'm doing a research project on the new bundling payment idea (sorta new I guess) of health reform. I am stuck on how this type of payment would lead doctors worried. I read something saying hospitals would get more power, but how is this possible?

Public Comments

1. Excerpts from an article in the Washington Post titled "Bundled payments might cut hospital costs without reducing quality of care" by By Manoj Jain (Jain is an infectious-disease specialist in Memphis and an adjunct assistant professor at the Rollins School of Public Health at Emory University in Atlanta.) "A majority of U.S. doctors earn their income through fee-for-service payments, and most adamantly oppose a change in this system. Some worry that in a bundled system they would become "slaves to the hospital." One internist at my hospital said, "Who will look after the patient's best interest?" It's true that a hospital-paid doctor might be tempted to put the hospital's best interest first." "Also, some doctors complain that bundled payment is reminiscent of the capitation fees that many HMOs implemented in their short-lived boom in the 1970s." "Bundled payments could be implemented fairly simply for common diagnoses such as pneumonia, heart attack and congestive heart failure. They would be more challenging to use with outpatient physician services, such as those that I offer my HIV patients. Outpatient care often requires multiple doctors, laboratory and radiology services. Bundling payments for all of them is difficult." "Bundled payments would almost certainly limit my income and, more important, reduce my autonomy. But health care should be about patients, not how doctors want to be paid. Sadly, the payment system is the tail that wags the dog in health care."
2. Doctors have autonomy now, because they bill the patient directly, and get paid directly. If the hospitals are the ones getting paid, they can dictate how much of that payment they keep, and how much they pass on to the doctor. They can say, well, we're only paying you $100 a surgery. As hospitals absorb a tremendous amount of care costs for nonpaying customers, it's very easy to see that they'll be KEEPING more of the payments, and NOT paying the doctors.
3. Because doctors wouldn't be able to continue their current scam of not taking insurance but working at a hospital that does. There's more to it than that, but that's an issue.