I'm not familiar with that group, but I'll try to look at them. "Patient-centered" sounds like it might address some of the problems I was just talking about. I myself was talking about the standards put out by professional groups, stuff like this:
http://www.guidelines.gov/syntheses/synthesis.aspx?id=16427 http://www.guidelines.gov/syntheses/synthesis.aspx?id=16405 I discovered while looking for an example that there's a .gov site that gathers them. I suppose this is a first step to rationalizing the process. And probably, in most cases, a good guideline will improve outcomes. The process needs to be responsive enough to deal with the situations I describes above though, not an easy goal for a big system. On Sun, Sep 25, 2011 at 10:45 AM, Gruss Gott <[email protected]> wrote: > > 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:343015 Subscription: http://www.houseoffusion.com/groups/cf-community/subscribe.cfm Unsubscribe: http://www.houseoffusion.com/groups/cf-community/unsubscribe.cfm
