The health care reform bills seek to hold down costs by offering added payments to hospitals with shorter lengths-of-stay. Wrong target, suggests a Long Island cardiologist in a sobering essay in today's New York Times. It's worth quoting at length:

Doctors, paid separately by Medicare, have little motivation to discharge patients quickly. As long as their patients are in the hospital, they can bill and be paid for each visit they make.

I discussed this issue with an internist in private practice, who requested anonymity because of the sensitive nature of the subject. His patients, it seemed to me, were often staying longer in my hospital than necessary. "I understand why hospitals want to cut down length-of-stay," he told me matter-of-factly. "But if I discharge a patient early, I don't get paid. It's O.K. if you have enough patients in the hospital, but if you don't, you sometimes have to drag out the stay. I don't like to do it, but sometimes you have to."

We talked about how private practitioners often resent hospital intrusion on their decision-making authority. "Some doctors get so mad at the hospital, but I don't because I realize it is just business," he said. "It has nothing to do with patient care. It's about money, pure and simple."

His conclusion is that the incentive payments (dare we call them bribes?) should be paid to physicians, not the hospitals. I have a better idea. Why not end fee-for-service medicine entirely. Salaried physicians would have no other incentive other than what's right for the patient. Isn't that what we all want?