Medicare Institutes New “Gratuity-Based” Compensation Plan

3K Shares

WASHINGTON, DC – The Centers for Medicare and Medicaid Services (CMS) began the rollout of their revolutionary new compensation model this week, in which physicians and nurses are paid on a gratuity basis.

Medicare gratuity plan
Intubation and central line…maybe like a $5 tip

“We don’t like to think of it as ‘working for tips,'” said Joan McWelters, senior spokesperson for CMS.  “We view this less as a way to cut physician and nurses’ salaries and more as a teensy-weensy modification to the ‘pay-for-performance’ plan and a reasonable cost control measure.”


The new gratuity-based system promises to revolutionize medicine by having doctors receive financial compensation directly from the patient in the form of a performance-based, voluntary contribution.  After each procedure or patient encounter, the patient will have the opportunity to either add an unspecified amount of gratuity to their receipt or place money in a special performance-based compensation receptacle (or “tip jar”).

According to CMS, with healthcare costs spiraling out of control, there has been a strong push from the White House to reduce unnecessary expenditures.  “A large portion – almost five percent – of our total healthcare budget goes toward physician and nurse salaries right now,” said McWelters.  “And we all know physicians don’t need more money.  Did you know that 78% of all physicians make more per hour than the average fast food worker? Outrageous!”

“And don’t get me started on nurses.  Most spend their time charting than actually taking care of patients!”

“The performance-based, voluntary contribution model has consistently been shown to improve service in the restaurant, transportation, and sex-worker industries,” McWelters said.  “What’s to say it won’t work here, too?”

But while government support for the new compensation model has been enthusiastic, physician and nurse support for the plan has been mixed.

“Today I saw a patient with a gunshot wound, an acute stroke, and a septic patient before noon and none of them tipped me a dime!” said Dr. Samantha Jones of Good Samaritan Hospital, Dover.  “Of course, then I saw this old guy with a broken ankle and let him grab my ass – he tipped me $20.  I guess the big tip was worth it.”

Some doctors, especially those in surgical fields, have had their pay so drastically cut by the new plan that they have been forced into other lines of work.

“I love doing open-heart surgery,” said Dr. Edward Lethem, Director of Cardiothoracic Surgery at Johns Hopkins.  “But I have to support my family and, lately, I haven’t been able to do that by saving people’s lives.”  This week, Dr. Lethem began a job working at a local T.G.I. Friday’s where he regularly makes $100-200 a night more than doing cardiac surgery.  “The money is better here, but the real appeal is getting to express myself with my little pieces of flair,” Dr. Lethem said, showing off his brand-new T.G.I. Friday’s vest covered in buttons.

Patients, while very accepting of the new system, are having a hard time understanding the changes.

“Mom was in the ER yesterday and they intubated her, shocked her, and sent her up to the cath lab where she an angioplasty that saved her life,” said DC local Scott Spinks.  “So how much do you tip the nurses and doctors for that?  Like, ten bucks or so?”

Another DC local, Martha Jenkins, recalled a recent pleasant emergency room experience that she credits to the new compensation scheme.

“I went in for my chronic abdominal pain and the whole time they were like, ‘What can we get for you, ma’am?’,” Jenkins said.  “They were courteous, they always kept my glass of Dilaudid filled, and they even brought me a complimentary order of fried mozzarella sticks. But, hey, I’m a good tipper.”

Detractors of the new compensation model are quick to point out that, contrary to the program’s intended goal, healthcare spending has actually increased since the initiation of the new payment plan.

“The establishment of a new branch of CMS and the hiring of an entire department of analysts and bureaucrats were some necessary up-front governmental costs in implementing this program,” McWelters said, speaking on behalf of CMS.  “But don’t worry, we’ve just established a new government committee to investigate that very problem.”

The committee’s report is anticipated to be released in early 2019.

SHARE