It doesn’t matter what industry that you are in.. unless you are paying attention to what is going on around you… you could find yourself off “in the ditch”.. Just like driving a car.. if all you do is look forward or only in the rear view mirror.. your “good driver” insurance discount won’t be around long.
http://www.kevinmd.com/blog/2013/02/patients-accountable-health.html
From the article:
That’s where the pay for performance thing is coming from. I am all for paying good doctors, but the quality metrics being used aren’t helpful. One of the measurements is how fast ER doctors can move patients out. But that depends in large part on other members and elements of the system over which she has no control. Another measure is re-admission rates, meaning how often are patients re-admitted within x amount of time being discharged. This is mostly a function of how many community supports the patient has, and is again not in the physicians control.
New York hospitals are moving to take away cost-of-living pay increases for doctors and link pay to quality measures, the so-called pay-for-performance method. The quality measures include how long a patient stays in the ER, heart attack recurrence, readmission to the hospital, dietary conversations with heart attack patients, patient satisfaction surveys, etc. This is in anticipation of what the Affordable Care Act may or may not impose.
Maybe this is why many of the chains are after Rx dept staff to call pt and badger them into getting refills… maybe they are anticipating their reimbursement being “dinged” if pts are not compliant.
No long-term cost savings with weight loss surgery
The headline says it all… apparently the study did not even begin to address a pt’s quality of life or life expectancy with or without the surgery… just the overall medical costs for the patient. Maybe all the rhetoric about better outcomes is acceptable… ONLY if it comes at a lower cost..
Feds Outline What Insurers Must Cover, Down To Polyp Removal
From the article:
The 149-page final rule retains requirements that insurers offer at least one drug per therapeutic category, or the same number as a state’s benchmark plan, whichever is greater. Many state benchmark plans require at least two drugs per class.
Responding to concerns from some advocacy groups, the final rule also states that insurers must have procedures to allow patients to get “clinically appropriate” prescriptions not on the plan’s list of covered medications.
“one drug per therapeutic category”… I hear… we are only going to pay for the cheapest drug available.. therapeutic outcomes are a secondary concern
“clinically appropriate “… how high is that hurdle going to be to get a drug approved ?
Filed under: General Problems
First, the article talks about the FDA urging drug companies to create less addicting drugs. My guess…never will happen. Some people get addicted to BC powder…some kids sniff glue. Most addiction is in the mind of the patient and not in the nature of the drug.
Second, The hospitals linking docs to performance is just another case of metrics gone amok. Just as we pharmacists are facing more and more metrics, looks like the docs are going to be facing the same thing. We all know that hospitals today are already kicking patients out of the hospital too soon.
Third, read the article where it talks about more responsibilities being dumped on the docs…seat belt use…smoking, and monitoring the pills to make sure patients are complaint.
Fourth, straight from the article: ” But the doctor has no control over these life-style choices, nor should he. Your doctor is there to treat you when you are sick and provide access to things that can keep you healthy, but the job of being and staying healthy is yours.” Doctors are not healthcare ‘cops’. They cannot imprison patients because they don’t follow the docs orders.
Fifth, straight from the article: “When a company or government wants to cut costs, one of the first things they do is examine where the money is going. The highest cost items are usually targeted first. Physician pay, as well as nursing pay, are necessarily big cost items and thus tend to be in the firing line. That’s where the pay for performance thing is coming from.” It is always the same old story with corporations and governments. Cut expenses…the first thing you do is cut employee salary and/or benefits. Same is coming to healthcare. They are looking for ways to cut reimbursement to physicians and hospitals. When will the insurance companies and the government start doing the same to pharmacy?
Sixth, straight from the article: “One of the measurements is how fast ER doctors can move patients out. But that depends in large part on other members and elements of the system over which she has no control. Another measure is re-admission rates, meaning how often are patients re-admitted within x amount of time being discharged. This is mostly a function of how many community supports the patient has, and is again not in the physicians control.” What we are seeing here with docs and the ER is the same thing we see with RiteAid and their 15 minute rx fill guarantee. The metrics do not take into account that some patients in the ER will require a lot of more the docs time than others. In pharmacy, there are so many problems that arise in filling a rx, that no metrics can be used for patient wait times. Each situation is unique!
Seventh, straight from the article: “My internship year, my first year out from medical school, was miserable in a hundred different ways, but one of the hardest things for me to deal with was the percentage of preventable disease I saw, diseases that are the result of what people have done to themselves. It is time to make the patient more accountable for his own health.” We see this in the pharmacy every day. We see how peoples lifestyles affect their health. In fact, lifestyle probably accounts from most healthcare problems and is most likely the leading cost in healthcare. But, pharmacists, physicians, nurses, and hospitals cannot control a patients lifestyle and cannot, in all good conscience, be held accountable for that lifestyle. The only thing to change a persons lifestyle is a ‘carrot and stick’ approach. Give them a reward for good behavior and punish them for bad behavior. If patients refuse to change their lifestyle, the docs and hospitals should not be held accountable. It is the patient that should be held accountable for their own behavior. We need to move away from the ‘nanny state’. I will go so far as to question why a patient, after being given fair warning and recommendations on how to change their lifestyle, then fail to change, should be given free healthcare or healthcare paid by tax money. The patient should have to pay for it out of their own pocket. If not, then let them suffer the consequences.
That is such a good article by Dr. Kevin. He points out the problems that we will be facing as we see more and more healthcare costs being cut by cutting providers based on metrics. Metrics will be the death of us all. Looks like, not on pharmacists, but all healthcare providers are going to ‘drown’ in all these stupid metrics.
About bariatric surgery, my guess is that it is a ‘mixed bag’, where some patients benefit significantly and others do not.
The article about Feds Outline What Insurers Must Cover, Down To Polyp Removal, is one of the first ‘price controls’. That is what it will be. The cheapest drug for a particular condition. We are heading down the same path as England. The next thing will be delayed surgery and maybe, depending on age, whether you get surgery or not.