Hello. Dr. Keith Smith with you – Surgery Center of Oklahoma. Thank you for joining us in this video blog series.


Here’s scam #2: ‘pay-for-performance.’ First, let’s cover ‘pay for no performance.’ That would be what HMOs or ACOs (Accountable Care Organizations) do. As we’ve discussed before, pay for no performance, or ACOs, they basically make money to the extent that care is denied or delayed. So all of the people who are ostensibly taking care of you make more money to the extent that you do not receive care, or the care you do receive is very delayed. That is, where people are actually paid to not perform.


Even creepier – and this is so counter-intuitive – is the concept and the scam ‘pay for performance.’ That sounds great on the surface, doesn’t it? We’re going to pay the surgeon, for instance, better if his patients do better. Well, the other side of that is, we’re not going to pay him as much if his patients don’t do well. That all makes sense, doesn’t it? …Until you put yourself in the surgeon’s shoes. Who realizes, for instance, that he is going to be profiled to the extent that his patients either do well or don’t do well. This will create a barrier for the sickest patients – the ones who actually need the care the most.


This is a rationing tool plain and simple. It’s particularly awful and it’s a scam because as the physicians begin showing reluctance to see these sick patients, knowing that they’re going to be profiled, the actual amount of money that Medicare bureaucrats actually can claim they’re saving goes up. So you have this celebration in Washington D.C. and the Medicare bureaucrats are saying ‘isn’t this wonderful? Look at how much money this has saved us!’ When really, out in the trenches, the patients who really need the care the most aren’t getting it.


Keep in mind that when someone says ‘pay for performance,’ this is really just a scam. This is a rationing tool. If someone says ‘accountable care organization,’ think: ‘pay for no performance.’ These are kind of two scams in one, but they basically work on the same principle.


We’ll have more for you in this series of video blogs on the scams of healthcare.


Thank you for joining us. We’ll see you next time