RE: Shock stuff: Provider exclusion and pay for performance: Insurance scramble

November 21, 2006

From the MD in Drain Oregon, In the last several months, 500

physicians from Washington have been excluded from the new Regency Blue Cross/Blue Shield "select network" for providing service that did not deliver "high quality, efficient" care. This included all the "pay for proformance" stuff that Medicare and other groups are talking about: diabetes management, hypertension management at certain levels and at certain speeds. Now, I was taught (all those years ago in veterinary school) that good medicine is judged by process, and not by outcome. For example, if we send a dart to an antibiotic-listing dartboard about which antibiotic to use and are lucky in our pick, it is still not a good enough procedure to think of as good medicine even if the patient gets well. If we are judged by outcome, many Mds will feel forced to try to fit the criteria. One way is that some MDs will exclude emotionally disturbed, alcoholic, intellectually challanged and other kinds of

people who are non-complient. That is what the insurance companies want: they want us to prescreen for them. How could we be willing to be part of this farce? Oh, yes, there is a lawsuit. That was because 8000 patients were sent letters that said their MDs did not meet the criteria of "high quality, effecient" service. These insurance manager guys are fighting us with slander and any other big guns they are allowed to use to make money. Remember, the corporate law quote: "the purpose of any regulation is that you may do anythimg up to the limit of that regulation" Also remember the quote from the Harard Business School graduation ceremony in 1992: "Greed is Good." These add up to companies collecting insurance premiums with no guarentee of service. As I predicted, the same insurance company has just arbitrarily dropped all medicare secondary PC 65 members in my county.

The patients are all scrambling to find insurance in the next two months. Please to note: I also predict that any insurance company that urges group insurance that has huge deductables is planning to leave that insurance area within five years. Why? Think! They know high deductables means no preventive care. They will not be around when the other shoe drops and the diabetes shows up, or the hypertension causes a stroke. These companies plan 25 years out. I know this, as my family members were within the planning circles of similar companies. Comment, please..... Come-on, Gordon, weren't you on a committee that worked on this planning for outcome management? Tell us what happened... Joann Holland DVM/Md

Sponsored Link$420,000 Mortgage for $1,399/month - Think You Pay Too Much For Your Mortgage? Find Out!

November 21, 2006

I guess

I’m still not clear on the whole pay for performance thing. If a

diabetic refuses to eat right, check his sugars, etc & his A1C remains over

10%, how can the doctor get dinged for that? I can not control the

patient’s every move & decision. What am I missing here?

Do patient’s have no personal responsibility, or is it just up to us to

motivate them & spoon feed them?

Re:

Shock stuff: Provider exclusion and pay for performance:

Insurance scramble

From the MD in Drain Oregon,

In the last several months, 500 physicians from

Washington have been excluded from the new Regency Blue Cross/Blue Shield

" select network " for providing service that did not deliver

" high quality, efficient " care. This included all the " pay

for proformance " stuff that Medicare and other groups are talking

about: diabetes management, hypertension management at certain levels and

at certain speeds.

Now, I was taught (all those years ago in veterinary

school) that good medicine is judged by process, and not by outcome. For

example, if we send a dart to an antibiotic-listing dartboard about which

antibiotic to use and are lucky in our pick, it is still not a good enough

procedure to think of as good medicine even if the patient gets well. If

we are judged by outcome, many Mds will feel forced to try to fit the

criteria. One way is that some MDs will exclude emotionally disturbed,

alcoholic, intellectually challanged and other kinds of people who are

non-complient. That is what the insurance companies want: they want

us to prescreen for them. How could we be willing to be part of this

farce?

Oh, yes, there is a lawsuit. That was because 8000 patients

were sent letters that said their MDs did not meet the criteria of " high

quality, effecient " service. These insurance manager guys are

fighting us with slander and any other big guns they are allowed to use to make

money. Remember, the corporate law quote: " the purpose of any regulation

is that you may do anythimg up to the limit of that regulation " Also

remember the quote from the Harard Business School graduation ceremony in

1992: " Greed is Good. " These add up to companies

collecting insurance premiums with no guarentee of service.

As I predicted, the same insurance company has just arbitrarily

dropped all medicare secondary PC 65 members in my county. The

patients are all scrambling to find insurance in the next two months.

Please to note: I also predict that any

insurance company that urges group insurance that has huge

deductables is planning to leave that insurance area within five

years. Why? Think! They know high deductables means no

preventive care. They will not be around when the other shoe drops and

the diabetes shows up, or the hypertension causes a stroke. These

companies plan 25 years out. I know this, as my family members were

within the planning circles of similar companies.

Comment, please..... Come-on, Gordon, weren't

you on a committee that worked on this planning for outcome management?

Tell us what happened...

Joann Holland DVM/Md

Sponsored Link

$420,000 Mortgage for $1,399/month - Think You Pay Too Much For Your

Mortgage? Find Out!

November 21, 2006

I think the better way to think of it is to do what's best for your patients. I would think that you would like to have better outcomes than most of your peers in your community. The only way to find out how you are doing is to measure it. I thought that I was doing very well taking care of my diabetic patients until I measured it. We made a very simple change of making a diabetic report card for every patient. Now I have patients reminding me that they need their microalbumin checked. Our next project will be a preventive health report for our patients along with a reminder system. Dentists have known for years that people do better with a reminder system. My vet sends me reminders for my dog's shots. I think that it is a no brainer that we should be doing at least this. You will never get every patient to do everything that you recommend but you can make dramatic changes by looking at your practice from a system perspective. We are just getting started at this. I'm sure others can give better examples. I think that the imp studies show that this model tends to produce better outcomes just by the nature of the practice. If we add careful disease management i think that most of us will excel in any pay for performance program.Larry LindemanRight, and what if my patients out here in Ohio just do not care about their health as much as the California or Oregon patients do? What if I order a mammogram but they just do not want to go or do not want to pay the co-pay, etc? Why should that be a black mark against me? I don’t get it. -----Original Message-----From: [mailto: ] On Behalf Of Larry LindemanSent: Tuesday, November 21, 2006 1:21 PMTo: Subject: Re: Shock stuff: Provider exclusion and pay for performance: Insurance scramble I have mixed feelings about this. I think that focusing on outcomes rather than processes is probably a good thing. How can you tell if your process is good if it doesn't lead to a good outcome. If you think that just giving an order for a mammogram is a good enough process you will not get the same results as a doctor who has a way of tracking and reminding people that they need mammograms. The outcome of breast cancer reduction might be difficult to measure as an outcome but the number of people who get mammograms in your practice is reasonable as opposed to how many you order. I think that this might lead to a lot of abuse because of the P4P part of it. Doctors might start to exclude more difficult patients. Doctors with small practices will not have enough patients for a good statistical sample. However, this push by Medicare and insurance companies for P4P is forcing doctors to take a hard look at their systems to improve their performance which will help most patients. Larry Lindeman MD From the MD in Drain Oregon, In the last several months, 500 physicians from Washington have been excluded from the new Regency Blue Cross/Blue Shield "select network" for providing service that did not deliver "high quality, efficient" care. This included all the "pay for proformance" stuff that Medicare and other groups are talking about: diabetes management, hypertension management at certain levels and at certain speeds. Now, I was taught (all those years ago in veterinary school) that good medicine is judged by process, and not by outcome. For example, if we send a dart to an antibiotic-listing dartboard about which antibiotic to use and are lucky in our pick, it is still not a good enough procedure to think of as good medicine even if the patient gets well. If we are judged by outcome, many Mds will feel forced to try to fit the criteria. One way is that some MDs will exclude emotionally disturbed, alcoholic, intellectually challanged and other kinds of people who are non-complient. That is what the insurance companies want: they want us to prescreen for them. How could we be willing to be part of this farce? Oh, yes, there is a lawsuit. That was because 8000 patients were sent letters that said their MDs did not meet the criteria of "high quality, effecient" service. These insurance manager guys are fighting us with slander and any other big guns they are allowed to use to make money. Remember, the corporate law quote: "the purpose of any regulation is that you may do anythimg up to the limit of that regulation" Also remember the quote from the Harard Business School graduation ceremony in 1992: "Greed is Good." These add up to companies collecting insurance premiums with no guarentee of service. As I predicted, the same insurance company has just arbitrarily dropped all medicare secondary PC 65 members in my county. The patients are all scrambling to find insurance in the next two months. Please to note: I also predict that any insurance company that urges group insurance that has huge deductables is planning to leave that insurance area within five years. Why? Think! They know high deductables means no preventive care. They will not be around when the other shoe drops and the diabetes shows up, or the hypertension causes a stroke. These companies plan 25 years out. I know this, as my family members were within the planning circles of similar companies. Comment, please..... Come-on, Gordon, weren't you on a committee that worked on this planning for outcome management? Tell us what happened... Joann Holland DVM/Md Sponsored Link$420,000 Mortgage for $1,399/month - Think You Pay Too Much For Your Mortgage? Find Out!

November 22, 2006

Larry - I'm sorry if this is repetitive, but can you post an example of the "report card" and how it reminds patients to anticipate their need for a urine microalbumin, for example?Thanks, I think the better way to think of it is to do what's best for your patients. I would think that you would like to have better outcomes than most of your peers in your community. The only way to find out how you are doing is to measure it. I thought that I was doing very well taking care of my diabetic patients until I measured it. We made a very simple change of making a diabetic report card for every patient. Now I have patients reminding me that they need their microalbumin checked. Our next project will be a preventive health report for our patients along with a reminder system. Dentists have known for years that people do better with a reminder system. My vet sends me reminders for my dog's shots. I think that it is a no brainer that we should be doing at least this. You will never get every patient to do everything that you recommend but you can make dramatic changes by looking at your practice from a system perspective. We are just getting started at this. I'm sure others can give better examples. I think that the imp studies show that this model tends to produce better outcomes just by the nature of the practice. If we add careful disease management i think that most of us will excel in any pay for performance program.Larry LindemanRight, and what if my patients out here in Ohio just do not care about their health as much as the California or Oregon patients do? What if I order a mammogram but they just do not want to go or do not want to pay the co-pay, etc? Why should that be a black mark against me? I don’t get it. -----Original Message-----From: [mailto: ] On Behalf Of Larry LindemanSent: Tuesday, November 21, 2006 1:21 PMTo: Subject: Re: Shock stuff: Provider exclusion and pay for performance: Insurance scramble I have mixed feelings about this. I think that focusing on outcomes rather than processes is probably a good thing. How can you tell if your process is good if it doesn't lead to a good outcome. If you think that just giving an order for a mammogram is a good enough process you will not get the same results as a doctor who has a way of tracking and reminding people that they need mammograms. The outcome of breast cancer reduction might be difficult to measure as an outcome but the number of people who get mammograms in your practice is reasonable as opposed to how many you order. I think that this might lead to a lot of abuse because of the P4P part of it. Doctors might start to exclude more difficult patients. Doctors with small practices will not have enough patients for a good statistical sample. However, this push by Medicare and insurance companies for P4P is forcing doctors to take a hard look at their systems to improve their performance which will help most patients. Larry Lindeman MD From the MD in Drain Oregon, In the last several months, 500 physicians from Washington have been excluded from the new Regency Blue Cross/Blue Shield "select network" for providing service that did not deliver "high quality, efficient" care. This included all the "pay for proformance" stuff that Medicare and other groups are talking about: diabetes management, hypertension management at certain levels and at certain speeds. Now, I was taught (all those years ago in veterinary school) that good medicine is judged by process, and not by outcome. For example, if we send a dart to an antibiotic-listing dartboard about which antibiotic to use and are lucky in our pick, it is still not a good enough procedure to think of as good medicine even if the patient gets well. If we are judged by outcome, many Mds will feel forced to try to fit the criteria. One way is that some MDs will exclude emotionally disturbed, alcoholic, intellectually challanged and other kinds of people who are non-complient. That is what the insurance companies want: they want us to prescreen for them. How could we be willing to be part of this farce? Oh, yes, there is a lawsuit. That was because 8000 patients were sent letters that said their MDs did not meet the criteria of "high quality, effecient" service. These insurance manager guys are fighting us with slander and any other big guns they are allowed to use to make money. Remember, the corporate law quote: "the purpose of any regulation is that you may do anythimg up to the limit of that regulation" Also remember the quote from the Harard Business School graduation ceremony in 1992: "Greed is Good." These add up to companies collecting insurance premiums with no guarentee of service. As I predicted, the same insurance company has just arbitrarily dropped all medicare secondary PC 65 members in my county. The patients are all scrambling to find insurance in the next two months. Please to note: I also predict that any insurance company that urges group insurance that has huge deductables is planning to leave that insurance area within five years. Why? Think! They know high deductables means no preventive care. They will not be around when the other shoe drops and the diabetes shows up, or the hypertension causes a stroke. These companies plan 25 years out. I know this, as my family members were within the planning circles of similar companies. Comment, please..... Come-on, Gordon, weren't you on a committee that worked on this planning for outcome management? Tell us what happened... Joann Holland DVM/Md Sponsored Link$420,000 Mortgage for $1,399/month - Think You Pay Too Much For Your Mortgage? Find Out!

November 22, 2006

Larry, I have no problem with sending reminders, giving patients an idea of where they stand with the norms of treatment, and doing charting of my diabetic patients labs and when standard tests or treatments are done: I started all that last year in fact. I have problems with insurance companies using their billing data to exclude providers from serving the patients. I don't (won't) deal with that company myself. However, I see this as a slippery slope. I think it is a kind of "No Child Left Behind" for physicians. Talk to teachers about pay for proformance and what it has done to schools and the children in them. I agree with Gordon that something has to change in the health care system. I believe we are the change. The discussion we have about all this is watched (I think) by other people who are also making change happen. Today I gave a call to a 44 year old patient I started to treat two weeks ago: she has been run through our current system for the last ten years: somehow the many MDs she has seen in the 10 minute visits allowed have missed her grade III holosystolic murmur and her myxomatous mitral valve. She saw the cardiologist I sent her to two days ago and is going in to have the valve replaced after a set of probably rather intrusive workups. I called her to reassure her about the procedures, and to let her know what to expect. Today I got a walk-in new patient with Grade three pitting edema, jaundice and 50 pounds of fluid wafting about in her abdomen. She has spent the last three months arguing with her "big practice" MD about not wanting to take glucophage for her blood sugars that

never go above 130. In the fuss, apparently he was too busy with the marginal diabetes to note the abdominal ultrasound done last Janurary that showed increased density of her liver (no masses) and a large spleen, that also recommended further biliary workup. I got it by calling the imaging center in a "fishing expedition". Then (In between patients) I got her set up with a gastroenterologist for next tuesday, collected her blood for the specialists workup and talked her into a second abdominal ultrasound...she was afraid of it because the last one had caused so much bruising. Oh, she is still going to be "non-compliant" about her diabetes, at least for the nonce. So what. You all will note that in the "pay for proformance" system as established by BC/BS in Washington, the other MD would be given extra points and I would not. Joanne Holland MD/DVM Drain, Oregon Larry Lindeman wrote: I think the better way to think of it is to do what's best for your patients. I would think that you would like to have better outcomes than most of your peers in your community. The only way to find out how you are

doing is to measure it. I thought that I was doing very well taking care of my diabetic patients until I measured it. We made a very simple change of making a diabetic report card for every patient. Now I have patients reminding me that they need their microalbumin checked. Our next project will be a preventive health report for our patients along with a reminder system. Dentists have known for years that people do better with a reminder system. My vet sends me reminders for my dog's shots. I think that it is a no brainer that we should be doing at least this. You will never get every patient to do everything that you recommend but you can make dramatic changes by looking at your practice from a system perspective. We are just getting started at this. I'm sure others can give better examples. I think that the imp studies show that this model tends to produce better outcomes just by the nature of the practice. If we add careful disease management i think that most of us

will excel in any pay for performance program. Larry Lindeman Right, and what if my patients out here in Ohio just do not care about their health as much as the California or Oregon patients do? What if I order a mammogram but they just do not want to go or do not want to pay the co-pay, etc? Why should that be a black mark against me? I don’t get it. -----Original Message-----From: [mailto: ] On Behalf Of

Larry LindemanSent: Tuesday, November 21, 2006 1:21 PMTo: Subject: Re: Shock stuff: Provider exclusion and pay for performance: Insurance scramble I have mixed feelings about this. I think that focusing on outcomes rather than processes is probably a good thing. How can you tell if your process is good if it doesn't lead to a good outcome. If you think that just giving an order for a mammogram is a good enough process you will not get the same results as a doctor who has a way of tracking and reminding people that they need mammograms. The outcome of breast cancer reduction might be difficult to measure as an outcome but the number of people who get mammograms in your practice is reasonable as opposed to how many you order. I think that this might lead to a lot of abuse because of the P4P part of it. Doctors might start to exclude more difficult patients. Doctors with small practices will not have enough patients for a good statistical sample. However, this push by Medicare and insurance companies for P4P is forcing doctors to take a hard look at their systems to improve their performance which will help most patients. Larry Lindeman MD From the MD in Drain Oregon, In the last several months, 500 physicians from Washington have been excluded from the new Regency Blue Cross/Blue Shield "select network" for providing service that did not deliver "high quality, efficient" care. This included all the "pay for proformance" stuff that Medicare and other groups are talking about: diabetes management, hypertension management at certain levels and at certain speeds. Now, I was taught (all those years ago in veterinary school) that good medicine is judged by process, and not by outcome. For example, if we send a dart to an antibiotic-listing

dartboard about which antibiotic to use and are lucky in our pick, it is still not a good enough procedure to think of as good medicine even if the patient gets well. If we are judged by outcome, many Mds will feel forced to try to fit the criteria. One way is that some MDs will exclude emotionally disturbed, alcoholic, intellectually challanged and other kinds of people who are non-complient. That is what the insurance companies want: they want us to prescreen for them. How could we be willing to be part of this farce? Oh, yes, there is a lawsuit. That was because 8000 patients were sent letters that said their MDs did not meet the criteria of "high quality, effecient" service. These insurance manager guys are fighting us with slander and any other big

guns they are allowed to use to make money. Remember, the corporate law quote: "the purpose of any regulation is that you may do anythimg up to the limit of that regulation" Also remember the quote from the Harard Business School graduation ceremony in 1992: "Greed is Good." These add up to companies collecting insurance premiums with no guarentee of service. As I predicted, the same insurance company has just arbitrarily dropped all medicare secondary PC 65 members in my county. The patients are all scrambling to find insurance in the next two months. Please to

note: I also predict that any insurance company that urges group insurance that has huge deductables is planning to leave that insurance area within five years. Why? Think! They know high deductables means no preventive care. They will not be around when the other shoe drops and the diabetes shows up, or the hypertension causes a stroke. These companies plan 25 years out. I know this, as my family members were within the planning circles of similar companies. Comment, please..... Come-on, Gordon, weren't you on a committee that worked on this planning for outcome management? Tell us what happened... Joann Holland DVM/Md Sponsored Link$420,000 Mortgage for $1,399/month - Think You Pay Too Much For Your Mortgage? Find Out!

Sponsored LinkWant a degree but can't afford to quit? Online degrees from top schools - in as fast as 1 year

November 22, 2006

Joanne --

Excellent anecdotes.

I'm on your side with P4P as I've had a taste of it, and how docs can

adjust their actions at my old job in a local hmo. Basically, about 8--10

years ago the group started chart reviews and kept track of pertinent

points which should be documented. The docs reviewed each others charts.

Then they used the numbers for a " quality " measure and that was part of

the bonus paid out at the end of the year. In the end, the docs learned

what had to be documented and adjusted their charting so the " quality "

percentages went up. Hopefully the docs actually were doing those things,

but who really knows. Ultimately the group stopped that because it was a

hassle and wasn't doing any good.

.... my point is, docs tend to be smart people. Once they know what

measures are used, they will adjust behaviors to improve them, perhaps

somewhat consciously, perhaps somewhat unconsciously, but they will. And

many other quality behaviors (many unmeasurable in insurance billing!) may

be left undone, ignored or deliberately delayed. Like I said, Joanne's

anecdotes are good examples.

P4P is potentially dangerous.

Tim

--

Malia, MD

Malia Family Medicine & Skin Sense Laser

6720 Pittsford-Palmyra Rd.

Perinton Square Mall

Fairport, NY 14450

(phone / fax)

www.relayhealth.com/doc/DrMalia

www.SkinSenseLaser.com

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> Larry,

> I have no problem with sending reminders, giving patients an idea of

> where they stand with the norms of treatment, and doing charting of

> my diabetic patients labs and when standard tests or treatments are

> done: I started all that last year in fact.

> I have problems with insurance companies using their billing data

> to exclude providers from serving the patients. I don't (won't)

> deal with that company myself. However, I see this as a slippery

> slope. I think it is a kind of " No Child Left Behind " for

> physicians. Talk to teachers about pay for proformance and what

> it has done to schools and the children in them. I agree with

> Gordon that something has to change in the health care system. I

> believe we are the change. The discussion we have about all this

> is watched (I think) by other people who are also making change

> happen.

>

> Today I gave a call to a 44 year old patient I started to treat

> two weeks ago: she has been run through our current system for

> the last ten years: somehow the many MDs she has seen in the

> 10 minute visits allowed have missed her grade III holosystolic

> murmur and her myxomatous mitral valve. She saw the

> cardiologist I sent her to two days ago and is going in to have

> the valve replaced after a set of probably rather intrusive

> workups. I called her to reassure her about the procedures,

> and to let her know what to expect.

> Today I got a walk-in new patient with Grade three pitting

> edema, jaundice and 50 pounds of fluid wafting about in her

> abdomen. She has spent the last three months arguing with her

> " big practice " MD about not wanting to take glucophage for her

> blood sugars that never go above 130. In the fuss, apparently

> he was too busy with the marginal diabetes to note the abdominal

> ultrasound done last Janurary that showed increased density of

> her liver (no masses) and a large spleen, that also recommended

> further biliary workup. I got it by calling the imaging center

> in a " fishing expedition " . Then (In between patients) I got her

> set up with a gastroenterologist for next tuesday, collected her

> blood for the specialists workup and talked her into a second

> abdominal ultrasound...she was afraid of it because the last one

> had caused so much bruising. Oh, she is still going to be

> " non-compliant " about her diabetes, at least for the nonce. So

> what. You all will note that in the " pay for proformance "

> system as established by BC/BS in Washington, the other MD would

> be given extra points and I would not.

>

> Joanne Holland MD/DVM Drain, Oregon

>

> Larry Lindeman wrote:

> I think the better way to think of it is to do what's best for

> your patients. I would think that you would like to have

> better outcomes than most of your peers in your community. The

> only way to find out how you are doing is to measure it. I

> thought that I was doing very well taking care of my diabetic

> patients until I measured it. We made a very simple change of

> making a diabetic report card for every patient. Now I have

> patients reminding me that they need their microalbumin

> checked. Our next project will be a preventive health report

> for our patients along with a reminder system. Dentists have

> known for years that people do better with a reminder system.

> My vet sends me reminders for my dog's shots. I think that it

> is a no brainer that we should be doing at least this. You

> will never get every patient to do everything that you

> recommend but you can make dramatic changes by looking at your

> practice from a system perspective. We are just getting

> started at this.

> I'm sure others can give better examples. I think that the imp studies

> show that this model tends to produce better outcomes just by the

> nature of the practice. If we add careful disease management i think

> that most of us will excel in any pay for performance program.

>

> Larry Lindeman

>

> Right, and what if my patients out here in Ohio just do not care

> about their health as much as the California or Oregon patients do?

> What if I order a mammogram but they just do not want to go or do

> not want to pay the co-pay, etc? Why should that be a black mark

> against me? I don’t get it.

>

> Re: Shock stuff: Provider exclusion and

> pay for performance: Insurance scramble

>

> I have mixed feelings about this. I think that focusing on

> outcomes rather than processes is probably a good thing. How can

> you tell if your process is good if it doesn't lead to a good

> outcome. If you think that just giving an order for a mammogram

> is a good enough process you will not get the same results as a

> doctor who has a way of tracking and reminding people that they

> need mammograms. The outcome of breast cancer reduction might be

> difficult to measure as an outcome but the number of people who

> get mammograms in your practice is reasonable as opposed to how

> many you order.

> I think that this might lead to a lot of abuse because of the P4P

> part of it. Doctors might start to exclude more difficult patients.

> Doctors with small practices will not have enough patients for a

> good statistical sample. However, this push by Medicare and

> insurance companies for P4P is forcing doctors to take a hard look

> at their systems to improve their performance which will help most

> patients.

>

> Larry Lindeman MD

>

> From the MD in Drain Oregon,

>

> In the last several months, 500 physicians from Washington have

> been excluded from the new Regency Blue Cross/Blue Shield " select

> network " for providing service that did not deliver " high quality,

> efficient " care. This included all the " pay for proformance "

> stuff that Medicare and other groups are talking about: diabetes

> management, hypertension management at certain levels and at

> certain speeds.

> Now, I was taught (all those years ago in veterinary school) that

> good medicine is judged by process, and not by outcome. For

> example, if we send a dart to an antibiotic-listing dartboard about

> which antibiotic to use and are lucky in our pick, it is still not

> a good enough procedure to think of as good medicine even if the

> patient gets well. If we are judged by outcome, many Mds will feel

> forced to try to fit the criteria. One way is that some MDs will

> exclude emotionally disturbed, alcoholic, intellectually challanged

> and other kinds of people who are non-complient. That is what the

> insurance companies want: they want us to prescreen for them. How

> could we be willing to be part of this farce?

> Oh, yes, there is a lawsuit. That was because 8000 patients were

> sent letters that said their MDs did not meet the criteria of " high

> quality, effecient " service. These insurance manager guys are

> fighting us with slander and any other big guns they are allowed to

> use to make money. Remember, the corporate law quote: " the purpose

> of any regulation is that you may do anythimg up to the limit of that

> regulation " Also remember the quote from the Harard Business School

> graduation ceremony in 1992: " Greed is Good. " These add up to

> companies collecting insurance premiums with no guarentee of

> service. As I predicted, the same insurance company has just

> arbitrarily dropped all medicare secondary PC 65 members in my

> county. The patients are all scrambling to find insurance in the

> next two months.

> Please to note: I also predict that any insurance company that

> urges group insurance that has huge deductables is planning to

> leave that insurance area within five years. Why? Think! They

> know high deductables means no preventive care. They will not be

> around when the other shoe drops and the diabetes shows up, or the

> hypertension causes a stroke. These companies plan 25 years out.

> I know this, as my family members were within the planning

> circles of similar companies.

> Comment, please..... Come-on, Gordon, weren't you on a committee

> that worked on this planning for outcome management? Tell us what

> happened...

>

> Joann Holland DVM/Md

>

> ---------------------------------

>

> Sponsored Link

>

> $420,000 Mortgage for $1,399/month - Think You Pay Too Much For Your

> Mortgage? Find Out!

>

> ---------------------------------

> Sponsored Link

>

> Want a degree but can't afford to quit? Online degrees from top schools

> - in as fast as 1 year

November 26, 2006

“I think that focusing

on outcomes rather than processes is probably a good thing. How can you tell if

your process is good if it doesn't lead to a good outcome.”

I have to strongly disagree with this. There are many

organizations testing “processes” and making “recommendations”

because they improve outcomes. There are many lousy doctors who have good

“outcomes” just because their patients come from strong stock and

good doctors who have lousy “outcomes” for the same reason.

Also, there may be doctors who don’t identify people as being diabetic

because their fasting sugar was 125 and don’t measure HgbA1C and the

outcomes might appear good because the bad ones aren’t checked.

If we are to be graded, it should be for effort. We don’t

control our patient’s behaviors and we don’t control their

protoplasm. How many of us have had someone have a heart attack who “shouldn’t

have’. They had no known identifiable risks, but there you have

it. Why wasn’t that person on ASA or a statin or a betablocker,

etc? Because I can’t foresee the future.

Anyway, quite frankly, the whole P4P shouldn’t exist until there

is a way to reliably measure in the first place. They don’t have a

way yet are trying to start programs anyway. That’s like trying to

time something before timing was invented.

Kathy Saradarian, MD

Branchville, NJ

Solo low-staff practice since

4/03

In practice since 9/90

Practice Partner User since 5/03

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RE: Shock stuff: Provider exclusion and pay for performance: Insurance scramble

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