From the time I was in grade school until just a few years ago, my parents owned a series of small neighborhood businesses. The first was a corner convenience store in an Italian neighborhood; eventually they traded up to three small clothing shops situated in neighborhood malls. Whether posted above the register or acknowledged during conversations, the message behind each transaction in every one of these stores was this: you were getting the best service and quality my parents could muster or you would get your money back.
Few people ever asked. My parents understood the power of warranties and developed a small army of loyal customers with relationships based not on money but on trust.
So I was more than intrigued last week when I read about the possibility of offering warranties to patients.
In the policy journal Health Affairs, Francois de Brantes, a nationally known advocate of health care quality, and his co-authors propose a new health care reimbursement model that comes with a warranty. Developed with the support of the Commonwealth Fund and the Robert Wood Johnson Foundation, this model, called Prometheus Payment, first offers set fees to providers. The fees cover all recommended services, treatments and procedures for specific conditions but are also "risk-adjusted" for patients who may be older or frail.
The warranty is based on the costs incurred by avoidable complications. In current fee-for-service plans, all costs from these complications are covered by the third party payer, regardless. But in the Prometheus Payment model, half of the costs from avoidable complications must be paid for by the providers themselves.
The result, Mr. de Brantes and his co-authors write, is a payment system that offers patients a health care warranty, since "providers win or lose financially based on their actual performance in reducing the incidence of avoidable complications."
I spoke recently with Mr. de Brantes and asked him about the Prometheus Plan, the feasibility of a warranty in the imperfect endeavor called "health care," and the potential impact such a plan might have on the patient-doctor relationship.
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