All good points, and this is why doctors don't like the governments ideas of "accountable care" organizations.
I have my own example too where i was told by my PCP and a specialist that condition X could not be controlled with action Y. Then I proved them both wrong. That said I would still say what's important is that they advise and start with the NCQA best practices. If a patient wants to deviate, fine, but document it and document why. On Sep 25, 2011, at 2:28 AM, Dana <[email protected]> wrote: > > 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:343014 Subscription: http://www.houseoffusion.com/groups/cf-community/subscribe.cfm Unsubscribe: http://www.houseoffusion.com/groups/cf-community/unsubscribe.cfm
