Btw, the National Quality Forum just debuted a beta version of its Quality Positioning System today. It's an online tool meant to allow users to search for NQF-endorsed quality measures depending on what setting you're in, the condition, data source, etc.
http://www.qualityforum.org/QPS/ Cheers, Judah On Sun, Sep 25, 2011 at 2:15 PM, Dana <[email protected]> wrote: > > 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:343044 Subscription: http://www.houseoffusion.com/groups/cf-community/subscribe.cfm Unsubscribe: http://www.houseoffusion.com/groups/cf-community/unsubscribe.cfm
