Martin
As much as an EMR can, could and should be used to improve thing for both the patient and the doctors, I can not back down from always oppossing a P4P type system. As long as we are treating free thinking, in a free society and free market human animals, way too many of the measured variables are simply outside the scope of the doctors' controls. And as a civil libertarian I would have no other way. You are teachers, advisors, leaders, but you are not big brother. And worse yet, big brother should not expect all of you to do half of their dirty work for them, nor do you have the invassive tools with which to do such.
I know you mean well, it is clear in you passion and well spoken position, but I fear folks like you (not you personally) only help feed into these bastards stance and make it all the harder to fight and resist. P4P is the road to your own bondage as a proffessional. You are the end provider or retail services and the real judge of you quality should be the second party in the relationship, your patients. Only in this insane business do we have 3rd and now even 4th party interlopers skimming all the cream off the top for their greed selves, denying the hardworking, well schooled, 1st party in such a relationship, you doctors, some of that cream that you worked so hard to have access to. Just like in free democratic elections, with very modest regulation, I think the patients know, they know who gives the good care and who is in and out of the room in 7 1/2 minutes. Let us start to freely charge and justify via competition who is the better of the practioners in town and I trust that armed with some good basic information, most patients will get it right.
You can have the factory down the road at 10% less or you can have my solo wife who knows your name, remembers your family members and your issues over here for 10% more. It's your call. In such a real free choice, free market, I think you would see some radical changes back to small personable practices that move at a slower pace and take better care of the patients in their care. But the expectation of a certain level of quality without the real possiblity of return on one's output of that quality is doomed to failure.
It is the medical equivalent of "No Child Left Behind". Instead of practicing medicine as you know you should, you will end up practicing to "the test"; just as all the teachers are doing now in all the school districts around the country. You will do what is measured, not what is proper or correct, or you will do both, what is correct because you know you should and have a conscience, and what is measured so as not to be penalized for doing the right thing, that is wasteful.
There will become a new class of patients who have bounced from doc to doc and practice to practice because they are outlayers and hurt your numbers, be it because they are difficult patients or because they have difficult bodies that are harder to pin down. Now that is truely bullcchitt. How many patients are you willing to dismiss and how quickly just to look good, just to keep your numbers up so you can be properly paid??? This should never even enter the equation and it certainly will in a P4P system. We must resist P4P at all costs. It is bad for patients and it is bad for docs. These two parties in the relationship actually do have a very symbiotic relationhip and so what is good or bad for one almost certainly affects the other likewise.
Let's keep medical choices in the hands of medical proffessionals, not bean counters who just want to make you all a bunch of monkeys chasing your tails. And while we're at, yes please arm docs with go products like AC with graphing and charting of various blood values and the like to empower you all with the best information to make those choices in the best manor possible. Isn't that a whole lot bette way to attach this monster?
But as to SF's real question. Unfortunately I think we are all just kind of riding the wave and making it up as we go along. Some of us have small ideas for a Schtick as Leslie puts it, but for the most part I see the tidal wave wiping most PCP's out...
"WIPE OUT!!!"
