Primary care physicians should receive pay by the hour

"We must make primary care a more manageable business by changing the way we pay for it," with primary care physicians paid by the hour, Robin Cook, a physician and author of the novel "Crisis," writes in a New York Times opinion piece.

According to Cook, under the current system, primary care physicians receive payments of about $50 per patient, regardless of the level of care provided.

He asks, "Why should the work of doctors be assessed this way" when other professionals, such as lawyers and accountants, charge clients based on the level of difficulty of the services provided.

Medicare "has made some adjustments to its reimbursement system to reflect the value of services provided," but the program "hasn't gone far enough," Cook writes, adding, "The pendulum must swing significantly farther toward primary care."

In the long term, he writes, "paying by the hour could save money" because physicians would have time to "investigate systems themselves rather than reflexively refer patients to specialists" and could "increase the pool of primary care doctors, so that more health problems could be handled in doctor's offices rather than in emergency rooms, where the cost of care is more expensive."

Cook concludes, "Paying for primary care by the hour would be better for both doctors and patients, and it would return a measure of rationality to our health care system" (Cook, New York Times, 8/30).