DocM,
I sorry but I just can't go there. I want to try and find you my old post about, "She Should Have Gone to Cornell" about how if my wife Nancy, an FP would have gone to Cornell School of Vetinary Medicine, Instead of SUNY Upstate how different our lives would be and how different our practice would be. I coached a great, intelligent, hardworking, creative kid, who not only at a somewhat small size was he one of my two best defensemen, but 12 years later, he is married and just about to graduate Cornell. I met him when Nancy was an MS 2 at SUNY.
So where is coach Paul and his wife as compared to this "KID" who is about to be brought under the wing of a good local vet who wants to just about hand him the keys to his practice some day? Who's time and money and efforts were better spent? Why does the vet down the road, who cares for Fido and Whiskers get paid at time of service, full charges that he sets at market rates for better or for worse, while guys like you and my wife have to deal with a legalized CARTEL who continues to increase their profits while they hold flat or reduce your rates based on JUNK science???
Outcome studies from clinical encounters are NEVER even single no less double blind. Both the patient and the doctor know what went down and who got what. How much bias is there in this stuff? Sorry but this kid from Da Bronx was a Pysch major and I learned more stats and experimental model in undergrad then many of you learned thru out all your studies.
Yes outcomes have their place, but what about the mouse chasing his tail just like in the big corporate practices? Do you remember the old anti-drug ad about snorting coke? The guy worked harder to by coke, so he bought more coke so he could work harder, so he had to work harded to buy more coke and the picture showed him zooming 90 degrees to the floor speeding around in a circle? This is productivity medicine. At what point do you reach a point of deminishing returns and become that rat chasing your own tail. At the large ugly corporate pratice Nancy left that was full of productivity, at some point there was nothing you could do, but slack off for a year or two, take the hit, so your numbers could go down, just so you could bring them back up again some time later... That is just insane. How about paying me appropriately for what I really do already?
Do you value it or not??? Just look at the relative value units and you'll see all you need to know. Procedures have great high values while office visits which PCP's live and die by are at the bottom or the heap. Don't get me started on IPA's and PO's that take better care of their specialists than their PCP's who then add insult to this injury with contracts that add an extra 10% to the fee shcedule for procedures as compared to OV's. BULL.
Well, are 50% of all docs bad docs with bad numbers? Somebody has got to be on the other half of the bell curve? What about patient free will to slowly kill themselves, with food, cigarettes, no seatbelts? Will you dismiss patients who don't fall into line and pass them on to the starving more compassionate docs? (Not implying your an SOB, but you get the point?) What about sticking with non-compliant patients and doing the best you can under the conditions at hand? And since when did we become the entire countries "Mother"? "Mrs Jones, I have you an order for a Mammogram (Bloodwork?) and we haven't seen the results and it has been three weeks now, did you go?" How many phonecalls, how many letters, at what point are you at 18 years of age or greater, a grown adult who must step up to the plate and take care of yourself for crying out loud?
We have a patient who is now on the other side of recovery, she now takes care of her family who used to take care of her, she is now the most responsible person in her group. But boy did it take forever to get there. The day we sent the request for her records to join the practice, the other pratice was probably laughing at us, they faxed them back the very same day... No CCHIT. We sent her the bad patient, you have 30 days at least once if not twice, but now here she is on the other side. P4P would have dictated dismissing her the first 3 months she was here, whine and spaced out. Now she has rejoined society and Nancy and I smile everytime we see her. It's like she was given a second lease on life and she knows she owes half of that to Nancy. And I always pump her up and tell her, "well we did show the horse the water, but you did most of the heavy lifting, by looking deep inside, working hard and getting well." They can take P4P put it you know where....
I guess I'm an old hockey coach at heart. Sure there are guys who's numbers are obvious and it is great to have a top scorer, or a guy with tons of assists who set up their teammates, or defensemen with great plus minus ratings, BUT, there are somethings that can't be measured or when you try to measure them in a small perspective, they look like they don't add up, but there are some guys who are bigger and more important than their numbers, those go to guys who are just born leaders, whether with words or by their actions on the ice. You just know you want them in your locker room come playoff time.
I guess what I'm saying in a real round about way is: You can't quantify only by healthcare costs alone the good docs and other providers do and don't do and it is very intentional to keep this agrument small and narrow on costs of care, drugs, verses revenue collected for that care. Because unless we measure the whole cost of lost lives, tax revenue, burdon to the system on the other side in terms on welfar, Medicare, Medicaid, Unemployment, disability, the impact of a disabled bread winner on the entire family and the local economy, they insurance carriers always win.... You just can't quantify what you guys do half the time, you can't prove or disprove what never happened to be measured and it is not on the insurance carriers books half the time anyway.
No less why is it always the docs who get cut, but never the MRI Manufacturers like GE, W-A here in my area, MidMark and all the large Pharmas? Why not control their prices? Half the stuff that Big Pharma has protected, its basic research almost always came from the tax payers with grants? When was the last time GE supplied CAT scans or MRI's at a loss like most of you docs provide your care?
Let good docs be good docs, and we'll get all the quality we will ever need. I still feel she should have gone to Cornell....
Good Night and Good Luck.....
Paul
