The legislature wants to save money on healthcare, and one issue has been whether it makes sense to penalize doctors who don’t keep costs down.
It’s called downside risk. And, broadly speaking, it means that doctors who care for patients should share some of the financial risk associated with that care. That is, if they spend too much money, they should have to share some of that extra cost.
Until this week, that concept was part of a proposed recommendation that would be voted on by the state’s Health Care Cabinet, chaired by Lt. Gov. Nancy Wyman. That risk model could have been in place over the next couple of years.
But advocates for the poor who get their coverage through Medicaid criticized the plan. Sheldon Toubman is one of them. He’s a lawyer with New Haven Legal Assistance, and he said it’s hard enough to get doctors to accept Medicaid; penalizing them would only make it harder.
“One of the concerns certainly is that we would start losing them when they say, you know, Medicaid doesn’t pay me that much anyway,” Toubman said. “And if I’m going to have to pay money back, forget it, I’m out of here.”
There are also fears that focusing on the cost of care alone could force doctors to limit the care they provide. AARP in Connecticut submitted a letter to the cabinet opposing the concept of downside risk, too, said Claudio Gualtieri, AARP’s associate state director.
“It actually creates this perverse incentive healthcare providers and doctors could be rewarded by cherry picking the patients that they serve and delaying or denying certain healthcare treatments that are more costly,” he said.
Hearing those concerns, it appears the cabinet may change course. If its first proposal was to implement downside risk over the next couple of years, the latest talk is that it wouldn’t happen until 2019 at the earliest. And if it does make that decision, it would only happen after serious discussion, according to Vicki Veltri, Wyman’s chief health policy advisor.
“I believe pretty strongly, if a recommendation went that way, we’d have to consider the points made by the advocates,” she said. The cabinet meets again next month.
Clarification: The cabinet won't implement downside risk until 2019 at the earliest because of both advocate concerns and a 2014 agreement it made citing consumer protection concerns, Wyman's office said.