They don’t care how much you know, until they know how much you care

DB’s rant:

[T]hose who champion P4P make an unfortunate assumption. They believe that you can push one button, and only impact the desired outcome. They are obsessed with measurement, and believe that measurement will improve health care. They are so dangerous.”

Brings to mind a phrase from the “Satisfaction Cult:”

they don’t care how much you know, until they know how much you care

Complicit with this assertion is the measuring and elevation of subjective reporting to objective fact. What is missed, is an appreciation for the limitations of the english language — where “you” is both the second-person singular and plural pronoun. The “Satisfaction Cult” (and the strong P4P-adherents) see “you” as singular and all statistical scores and variances are singular in origin and causality. Wonder if “you” is plural? Then scores and variances are matters of plurality and causality is never found. Which “you” smacks of reality?

Unethical to alter and tweak…

USA Today: Dr. Daniel Carlat sank into a choice seat at Lincoln Center, surrounded by other psychiatrists, all staying at the same four-star hotel in Manhattan and attending the same show for free. His deal with a pharmaceutical company to provide testimonials to other doctors had paid off well…[but] I stopped because I decided that it was unethical to alter and to tweak information that would ultimately affect patients’ welfare and patient safety[.]“

Your Business

Your Doctor’s Business Is Your Business | WSJ | 11.20.07

“There should be a discussion between physicians and patients about financial involvements,” says Dr. Zuckerman, chairman of orthopedic surgery at NYU Hospital for Joint Diseases. “As time goes on, patients will add this to the list of questions they have.”

In the end, patients shouldn’t be put in the position of having to quiz their doctor on his or her business practices, says David Blumenthal, a Massachusetts General Hospital researcher who studies conflict-of-interest issues. He says the onus should be on doctors, insurers and hospitals to inform patients of any stake they have in a treatment.

What Experts Recommend:

• Ask if your doctor has any financial connection to the recommended treatment.
• If the answer is yes, seek a second opinion.
• If unwilling to ask the doctor, do research on the Web

Adam Smith Turns Over

Uwe Reinhardt eloquence:

[O]n 10 July 2007, President Bush casually shrugged off the plight of the uninsured with the remark, “I mean, people have access to health care in America. After all, you just go to an emergency room”—with nary a concern expressed over how these emergency rooms will cover their costs.

Absolutely without intending to do so, the efforts of US healthcare providers to cater to uninsured people have aided and abetted great irresponsibility among the nation’s political leaders, thereby perpetuating the plight of the uninsured. This is so because the benevolence of health professionals has provided political leaders with moral coverage for resisting any and all efforts to move the nation at long last to fully universal health insurance. By their benevolent ingenuity healthcare professionals in the US have, albeit unwittingly, allowed politicians to go to church or synagogue and feel right with God, just after voting down the latest proposal for universal coverage.

Medical Screaming Exam

Doctor tried to avoid giving ER care to poor, state finds | Des Moines Register | 11.9.07

A doctor at Davis County Hospital in Bloomfield tried to avoid treating low-income people in the hospital’s emergency room by minimizing their concerns, a state appeal board has found.

In one case, police arrived at the hospital May 28 asking for help with a person who had taken what they said were “a bunch of pills.” [The physician] allegedly “blew up” at the officers and said, “What am I supposed to do with her? We don’t do that here,” and told the officers to take the woman to a different hospital.

Iowa’s Title 19 (Medicaid) or EMTALA or both? An obvious mistake — a medical screaming exam instead of a medical screening exam (MSE) …

Ethical Lowlands

Health insurer tied bonuses to dropping sick policyholders | LAT | 11.9.07

Woodland Hills-based Health Insurance Inc. avoided paying $35.5 million in medical expenses by rescinding about 1,600 policies between 2000 and 2006. During that period, it paid its senior analyst in charge of cancellations more than $20,000 in bonuses based in part on her meeting or exceeding annual targets for revoking policies, documents disclosed Thursday showed.

The revelation that the health plan had cancellation goals and bonuses comes amid a storm of controversy over the industry-wide but long-hidden practice of rescinding coverage after expensive medical treatments have been authorized.

Great opportunity for the legislature to step-in and correct these ethical behavioral lapses… How much of healthcare delivery is financially incentivized by the denial of benefits or termination of coverage by payers and the over-utilization of reimbursable services by providers? Do insurers inhabit the ethical-lowlands alone?

Valid Criticism: Mascot

Emergency Medicine’s mascot? Shouldn’t be!

Outside Hospital

Concierge Medicine

Concierge medicine: Rx for stressed health care system? | AJC | 11.8.07

Concierge medicine — the name itself implying highly personalized services — has sprouted as a rebellion against what’s perceived as assembly-line medicine. The doctors flee the frenetic pace and hassles of traditional practices, and limit their practice loads. Patients, in exchange for $1,500 or more a year, get 24/7 convenience and added face time with a doctor.

In the past five years, concierge practices have gained a small foothold in major cities. But these arrangements — also known as boutique practices — raise tough ethical questions:

• In a system that already has a shortage of primary care doctors, does concierge medicine siphon off valuable resources?
• Does it create a two-tiered medical system, one for the well-off and one for everyone else?

We have this in the ER, except for the $1,500/year and the wait…

e-Carrots

Medicare docs can get bonuses for using EHRs and e-prescribing in 2008 | GHIT | 11.5.07

For the first time, the Medicare program will pay bonuses to doctors and other health care providers for using electronic health records and e-prescribing in 2008.

Use of the two technologies are among 119 quality measures that the Centers for Medicare and Medicaid Services listed in an official notice of its payment rules for the coming year.

To qualify for a bonus of as much as 1.5 percent of their Medicare fees, doctors can report their compliance with as many as three of the 119 measures. A pool of $1.35 billion will be available to pay incentives next year.

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