There are a number of surgical options around widely prevalent conditions such as incontinence. It affects an estimated 25 million men and women across the U.S. As these individuals explore possible treatments they feel they are in good hands — they've worked with their doctors often for years and formed a mutual understanding and trust. Although they're dreading the risks and recovery associated with the procedure, they find comfort in the fact that they'll be well taken care of. What they don't know, but probably should, is what's happening behind the scenes at the hospital that could have a devastating impact on the surgical and management alternatives offered to them.

The doctor's role first and foremost is to serve as the advocate in the best interest of the patient. The idea of gainsharing, however, is intended to draw doctors toward the least expensive treatment option, period. I believe the patient's comfort, safety and care should come first. Restoring the quality of people's lives with outcomes that meet expectations should not come in second place to a gainsharing arrangement between doctors and hospitals.

Unbeknownst to patients, the hospital where surgery is set to take place may have signed a gainsharing agreement under which doctors may be discouraged from performing a surgery with the best device for the job. For example, devices are now available for the surgical repair of vaginal wall prolapse. Products for a comprehensive repair procedure cost twice ($3,800) that of the simple mesh ($1,500) used in the past in an anterior colporrhaphy involving plication and suturing of already compromised vaginal tissue. The newer procedure, however, cuts OR time in half, minimizing blood loss with fewer dissections, and drops the recurrence rate. Perhaps more importantly, the newer procedure with advanced designed devices restore the patient's normal, anatomically correct support. However, hospitals influenced by gainsharing could be unduly influenced by what appears to be a $2,300 savings in product costs alone. That ignores OR time, the risks associated with lack of standardization in technique, and both short-term and long-term outcomes with respect to reliability, safety and ultimately patient satisfaction. In sum, patient considerations could be hijacked in the process.

While the National Association For Continence is not endorsing a particular surgical-device company or its products, I share the example to illustrate the potential harm inflicted by such an agreement. Gainsharing makes sense on a factory-floor. There it is an incentive-based, cost savings concept that typically offers workers a monetary share of savings they create through increased efficiencies and cost reductions. When applied to healthcare, however, gainsharing becomes a troubling scenario. It creates a conflict of interests for physicians and may constrict patients' access to critical, even lifesaving technologies and procedures.

Under healthcare gainsharing, hospitals and physicians share money generated not from efficiencies that enhance patient care, but rather from limitations on a physician's choice of medical technologies. Essentially, doctors are paid to use only the cheapest equipment or devices, or those that are part of a supply contract for which the hospital has negotiated a volume purchase.

While efforts to reduce wasteful costs in the healthcare system are necessary and appropriate, gainsharing incentive programs are grounded in the misconception that physicians who generate more costly services are not efficient. However, innovative medical technologies and treatments can initially be more costly than existing treatments. Accepted advancements such as coronary bypass, angioplasty and stents, artificial hips and knees, all at one time or another have been thought to be expensive. Now we know that the clinical benefits derived from these technologies result in faster recovery times, shorter hospital stays, and less invasive procedures.

The doctor-patient relationship will be undermined by creating a potential conflict of interest for physicians between personal economic interests and the responsibility to provide the best possible outcome for patients. Such ethical dilemmas and financial deterrents may compromise the quality of services, including medical devices, diagnostic tests and, most importantly, patient care.

The way to save money in health care is to let doctors do what they do best: use the best tools available to cure people and keep them healthy. Gainsharing promises no gain. And paying doctors to take shortcuts today could well mean that Americans will pay more for comprimised treatment and care.