I'm not convinced that suckage folllows. I don't want to get into the specifics of my example on the spidered internet, but look at the range of treatment options for high blood pressure, diabetes and high cholesterol. For example. That's a big chunk of preventable illness there, but there could be good reasons to treat those particular conditions with anything from heavy-duty meds with serious possible side effects to a diet and exercise program. And the deciding factors are all n the patient side : will they really change their diet? Are they more afraid of the condition, or of the side effects? Do they believe that they themselves have the power to make a difference? Will they actually fill the prescription? I'm not an expert on these conditions as I don't have them, but I imagine that there are measurable data points as well... how high is the cholesterol, what's the family history.... but look at how much the other factors matter.
The *are* situations where standards of care are appropriate. The author of that book -- a Harvard medical professor btw -- mentions heart attacks at the ER. I've said before myself that I almost prefer to see a physician's assistant or nurse practitioner for primary care. They tend to be less harried and to listen better and I'm pretty sure a lot of them are in fact methodically going down a list. That's how I got scheduled for a sleep study, which did me vast amounts of good. However. If the standard of care for a condition is x, and *then* a study comes out saying that in a couple of hundred patients followed for five years, x turned out to cause serious injury in oh half the patients, and yet did no better than a placebo, I really really want my doctor to not be afraid of telling me that lest he or she get a black mark for deviating from the standard of care. Because they would be of course, if the academy of whatever has not yet held a committee meeting on the subject. That said, perhaps there's an algorithm that takes all this into account? But I suspect that there are too many unknowns from the doctor's point of view. I strongly suggest you take a look at that analysis when you get a chance. I found it quite thoughtful and quite damning. Dana On Sat,ep 24, 2011 at 11:36 PM, Gruss Gott <[email protected]> wrote > > Oh, and definitely docs should be measured on how they well follow diagnosis > and treatment best practices, I.e. "quality". If they work outside of them, > then the measure is on outcomes. > > Who wants to go to a doc that doesn't follow industry best practices for > diagnosis and treatment and who's outcomes suck? > On Sep 24, 2011, at 11:46 PM, Dana <[email protected]> wrote: > > > > > meh. I read it. The main point seemed to be that someone might lose a > > laptop. That's a valid concern but it's not specific to the federal > > government. I'm not entirely sure that the Examiner reporter read the > > regulation. I have pretty high tolerance for wonkish stuff, and I have to > > say that my eyes glazed over...But here's what I got out of a skim: > > > > There's a concern that insurers will have many new patients with deferred > > medical issues which will increase insurer risk for a few years, They are > > proposing a reinsurance program, how heinous ;) It also looks like they're > > suggesting that some insurers could use technical support for data analysis > > as well. And if they're going to spend money they want to be able to audit > > the programs that get it. I would too. > > > > The Examiner seems to be up in arms about the feds looking at data, but > > yanno... they already do have the very large datasets from Medicaid and > > Medicare. They are asking for comment on how best to handle this. The nerve > > of them ;) They also say that although HIPPA does not strictly apply they > > want to use it as a standard anyway. Like everyone else in the medical field > > does, or perhaps should would be a better word. > > > > What I don't see is any indication that they're proposing to go through > > patient charts and line by line require justification for each expenditure. > > You know. Like your current insurance does? > > > > 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:343011 Subscription: http://www.houseoffusion.com/groups/cf-community/subscribe.cfm Unsubscribe: http://www.houseoffusion.com/groups/cf-community/unsubscribe.cfm
