Folks,
Personally I suggest that nobody does. We all need to resist. I hope nobody submits anything. Otherwise we are just feeding into this misconcieved idea of we the providers have the ultimate control over patient outcomes, when in reality we are but tutors and guides. There are numerous other factors that affect outcomes way before we get involved. Diet, food availible or not avialable at Supermarkets and restuarants, choice of activity level, use of recreational things (tobacco, Booze, ect...), work type and OT, enviornmental things be they chemical or psycho-social and the like, Family history, personality and cooperation with ones own care.
P4P is BullCCHIT. Since when did I become your mother??? And since when did emancipated adults, supposedly free citizens in a supposedly free society, suddenly become minors who can not care for or be responsible themselves and for their own healthcare; there by requiring that we become their "Health Guardian", who have been unwillingly appointed for them as such, so that we are now legally and otherwise responsible for their care and the managment there of??? We can advise, we can suggest, we can educate, but in the end, in the final analysis we are but tour guides.
"You can lead a horse to water, but you can't make him drink." We just got chart requests from a Managed Medicare plan for this husband and wife's charts for quality purposes. This couple is classic. He brings his fairly frail and sick wife in all the time, but now matter how much we bug, poke or prod him, we just can not get him to give us a visit and get some labs done so we can take care of the caregiver. How much is this male resistance to medical care, his feeling overwhelmed, or what I don't know, but we just can not get this guy to let Nancy have half a shot at him.... Even though he is coming in anyway with his wife and we would gladly see them back to back, at the very same time so he doesn't have to worry about her or even make a separate trip. He just won't do it and we are powerless to change that until something inside of him changes. And they both adore Nancy and apperciate this office so the doc is probably not the issue either.
We do not live in a totalitarian state were like big brother we have the power and the means to follow free citizens around, taking away their cigarettes, picking the food for their shopping carts, make them put on a condom. I don't see big brother like TV screens and cameras in peoples cars and homes, at least not yet. Although Gonzo and Bush certainly did try and Bush seems to be continuing to do so. There is the wonderful, free thinking, unpredictable, erect walking, tool using animal in the middle of all this and he/she tends to screw things up to hell, just as he/she should and hopefully always will.
P4P is but a new twist on the old game of developing new bullcchit programs and cover stories to take away money from provders and instead keep it in the insurance industries pockets for their greedy selves. Goodness only knows what their next well thought out scam will be... But I'm sure there will be others to come. There always are, right???
Happy and Health to one and all, Catch ya Next Year...
Paul
