I'll chime in here with something I heard on* Fresh Air* that I find a bit alarming:
apparently the current administration thinking for health care is to mandate following best practices, and penalize doctors for deviating from them. This might seem like a no-brainer, but events over here have had me making some medical decisions for my family this year, and I've learned that the "standard of care" is about five years behind at a minimum. That too might seem like a good thing -- who wants impulsive medical decisions? But following conventional wisdom in this case would have involved big risks with no benefit at all, with multiple recent large studies to prove this point. So guess what we decided? I thanked that doctor for making sure I understood that. I'd hate to see doctors lose the freedom to do present the pros and cons. It's not always that clear-cut, of course. But even when it's not, there can be good reason for deviating from what sounds suspiciously like a medical No Child left Behind. Anyone know anything about this proposal? Here's my source. It seems pretty authoritative, and I don't think I'm misunderstanding it: http://www.npr.org/books/titles/140439006/your-medical-mind-how-to-decide-whats-right-for-you#excerpt for example: It's also important for patients to realize that guidelines aren't engraved in stone; they can change quickly. A survey of one hundred recommendations from expert committees found that within a year 14 percent were reversed, within two years 23 percent were changed, and fully half were overturned at five and a half years. The American College of Physicians, representing internists in the United States, stated in 2010 that all of its guidelines, if not rewritten, should be automatically suspended after five years. This isn't only because new and better data become available, but also because the composition of expert committees may change, and with this change, subjective judgments of "utility" or value may shift . Consider the guidelines that recommended the use of estrogen in virtually all postmenopausal women to prevent heart disease and dementia. These guidelines were overturned by new information from the Women's Health Initiative trial. Yet some experts remain critical of this study and still endorse parts of the earlier guidelines, believing that for some women the "value" of hormone replacement may be enough to risk the downsides. Clearly, more than assessments of scientific evidence, more than extracting numbers from clinical research, goes into guidelines and their recommendations. The conclusions drawn about what is "best" necessarily incorporate the second part of the Bernoulli formula, the "value" or impact of a treatment on quality of life. For every individual, this impact is always subjective and cannot be distilled from objective data. We believe that all patients should be fully informed about their condition and then asked about their preferences. Such "informed patient preference" is placed by the Institute of Medicine of the National Academy of Sciences at the pinnacle of "quality care." To be truly informed, patients should be aware of the gray zones in medicine. They must keep in mind that guidelines are not purely scientific and have a significant subjective component. On Fri, Sep 23, 2011 at 10:02 PM, Gruss Gott <[email protected]> wrote: > > All provider claims for risk adjusted Medicare advantage are currently > submitted to CMS's RAPS system, but it only requires 5 fields. Soon they > will be getting full 837 claims via the new EDPS system. > > It's very common to run analytics on this data for purposes of finding > under treated patients. You can even power campaigns by using the lack of > data. For example, no physical therapy claim after knee surgery, or no > vasodilator if the patient is HCC 16 (diabetes w vascular complications), or > even simply no PCP visit this year. > > In other words, seems like the government already has this data, however > given their historical expertise in manipulating it I wouldn't be too > worried. > > That said I didn't read the link :) > > > > On Sep 23, 2011, at 10:00 PM, Robert Munn <[email protected]> wrote: > > > > > cool, thanks! > > > > On Fri, Sep 23, 2011 at 7:49 PM, Judah McAuley <[email protected]> > wrote: > > > >> > >> I don't think this is accurate. I glanced at the rule when it was > >> proposed and there hasn't been any uproar in the medical world that > >> I've seen, so I'm dubious. But I don't know for certain. I'll do some > >> investigation and try to reply back here in a couple days. > >> > >> Judah > >> > > > > > > > > ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~| Order the Adobe Coldfusion Anthology now! http://www.amazon.com/Adobe-Coldfusion-Anthology/dp/1430272155/?tag=houseoffusion Archive: http://www.houseoffusion.com/groups/cf-community/message.cfm/messageid:343007 Subscription: http://www.houseoffusion.com/groups/cf-community/subscribe.cfm Unsubscribe: http://www.houseoffusion.com/groups/cf-community/unsubscribe.cfm
