GREEN BAY, Wis. (WBAY) - A Green Bay doctor is helping to lead the charge for changes in the way doctors treat their patients.
Dr. Ashok Rai, Prevea president and CEO, advocates for "value-based health care."
"Really, it is redesigning how we practice," Rai says. "The physician is no longer the focus of the health care system; the patient should be."
Currently, the more procedures that are done on a patient, the more doctors are paid. It's called Fee for Service.
Dr. Rai, the Board Chair of the American Medical Group Association, advocates for the opposite approach. He wants to see doctors rewarded and paid based on the quality of their work -- keeping people healthy.
"Currently, how most health care insurance works, when they pay doctors, they pay you when you get sick. So when you come to the hospital, a doctor will get paid. When you come to the office, they will get paid. That's what's called Fee for Service. You're charged a fee for a service," Rai explains.
Last week, Dr. Rai was one of five physicians asked to testify on Capitol Hill before the Energy and Commerce Committee. It oversees Medicare Part B.
In 2015, Congress passed a health care law to revamp the Medicare program in an effort to sustain it.
"Currently health care is paid when you get sick, and the sicker you get, the more money a health care system gets," Rai said. "What Congress would like to do -- and actually we'd like the whole country to eventually evolve to -- is what we call 'value-based health care,' when you're actually paid to keep a patient healthy."
Dr. Rai says a majority of doctors across the country have not bought into the idea.
"Sixty percent have been excluded because they would not have 'done well' under the law, so they would have been penalized under Medicare," Rai says "You think about ... for 100-plus years, our infrastructure has been based around treating you when you're sick. To create an infrastructure to keep people healthy, although it may seem like it's common sense, is completely flicking the switch in the other direction. So the investments necessary are pretty significant."
Rai testified that providers like Prevea have invested millions of dollars into this new focus on wellness. However, they're not receiving financial benefits expected because some doctors are not practicing this way.
While the shift to wellness and prevention will likely take a long time, Dr. Rai says the proof it works can be found in Northeast Wisconsin.
That's why he was asked to testify.
"It was a unique experience to be able to not only talk about health care but to talk about our own group and performance, which one of the congressmen said was impressive," Rai said. "So it was nice to be able to hear that."