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Does Pay for Performance Measure Medical Quality?

If you read this blog, then you likely know about the scam known as Pay for Performance (P4P).  This program not only fails to deliver on its stated mission to improve medical quality, but it actually diminishes it.  For a fuller explanation on why this is true, simply insert ‘Pay for Performance’ into this blog’s search box, and grab some Rolaids.  In short, P4P pays physicians (or hospitals) more if certain benchmarks are met.  More accurately, those who do not achieve these benchmarks are penalized financially.   I do not object to this concept.  Folks who perform at a higher level should be rewarded accordingly.   My objection is that the benchmarks that have been selected are arbitrary and too far removed from true medical quality measurements.  Benchmarks have been chosen that are easy to measure even if these measurements don’t count for much.  In other words, what really counts in medicine, isn’t easy to count or measure. Medical Quality Measurement Instrument Co

Are Emergency Rooms Admitting Too Many Patients?

This blog has discussed conflicts of interests.  Indeed, every player in the medical arena has found itself challenged by conflicts where one’s self-interest competes can skew what should be pure advice.   This issue is not restricted to the medical universe.  Every one of us has to navigate through similar circumstances throughout the journey of life.  If an attorney, for example, is paid by the hour, then there is an incentive for the legal task to take longer than it might if the client were paying a flat fee.  The fee-for-service (FFS) payment system that had been the standard reimbursement model in medicine has been challenged and is being dismantled because of obvious conflicts that were present.  (This is not the only reason that FFS is under attack, but it is the principal reason offered by FFS antagonists.)  Physicians who were paid for each procedure they performed , performed more procedures.   This has been well documented.  Of course many other professions and trades stil

Should Physicians Offer Disclaimers to Patients?

Why does is seem that so much information given to us comes with disclaimers?  The weight loss product ads on TV that promise more than they will deliver, are always accompanied by 5 nanosecond disclaimers in a font size that can’t be discerned by the human retina stating that the results are not typical. Watch the Pounds Melt Away! It seems deceptive to be advertising a product by showcasing a performance that the vendor admits is not typical. Let’s extend this philosophy to other professions and trades. Financial Planner:   Invest with us and earn 20% returns annually over 5 years. Results not typical. Attorney: When I catch your ambulance, I’ll make us both millionaires!  Results not typical. SAT Tutor:  My students have the dilemma of choosing between Harvard and Princeton.   Make your kids my kids. Results not typical. Airline Industry:  When our customers call us on the 800 line, a live human answers by the 3 rd ring. Results not typical. Politician:  I wi

Why I'm Against Wellness

I’m a physician and I’m against wellness.  Let me explain. Wellness is the new health mantra that has much more to do with marketing than with evidence-based medicine.  Wellness institutions and practitioners are omnipresent promising benefits that are often untested or rejected scientifically.   Hospitals that years ago would have shunned new age healing arts, now offer yoga, meditation, Reiki and massotherapy.  Do they do so because they have had a Damascus Road experience and now believe that these techniques are effective?  Guess again. Paul's Conversion on the Damascus Road Wellness is no longer restricted to medical campuses, costly weekend retreats for emotional and physical catharses and ubiquitous yoga storefronts.  Wellness is now championed by corporate America.   Business leaders argue that keeping employees well is not only a demonstration of good corporate citizenship, but is also good business.   Healthy employees, they claim, will reduce health care

Are Doctors Sued Enough for Medical Malpractice?

Remember personal responsibility?  There actually was an Era of Responsibility when folks admitted when they screwed up and didn’t blame others for their own mistakes.  I know this may seem incredible to the younger generation who simply assume that when something goes wrong today, it must be someone else’s fault.   In today’s culture, this is not scapegoating, but the pursuit of justice.  Welcome to the Era of Big Victim. In the olden days, if someone slipped on ice and sustained injuries, he went to a doctor. Today, we could expect a court case where a jury would hear testimony from an Illumination Expert testifying that the wattage and angle of the sidewalk lighting was clearly deficient.   A Saline Expert would add that the salt that the proprietor applied to the sidewalk was not dispensed with a certified salt sprayer, thereby allowing dangerous ice crystals to survive.  Perhaps, an Ambulation Expert would instruct the jury that the soles of the fallen man’s shoes containe

Security vs Freedom: TSA Airline Security Gave me a Free Pass

I’m writing this aboard a United Airlines flight on route to Chicago.  I haven’t had this much leg room since I was inside my mother’s womb.   I am now in fear that if the gentleman in front of me reclines his seat, that it will disfigure me.  If this occurs, I wonder if United would be liable for my pain and suffering.   Now that I think about, throw that seat back, buddy! Stretch out and relax! I shouldn’t carp on United as I received an unexpected prize from the airline.  When I passed through the TSA checkpoint, I was told that I had been awarded a Pre-Check status, which conferred valuable privileges.  This meant that I did not have to remove my shoes or my jacket.  Somehow, the airline had determined that the Whistleblower posed no flight risk.  Luckily, the airline had not read some of my scathing Whistleblower posts on their pricing strategy and their deep commitment to customer service. Do you think that they profiled me to determine that my shoes likely contain

Can We Survive an Epidemic of Corporate Wellness?

I’m a physician and I’m against wellness.  Let me explain. Wellness is the new health mantra that has much more to do with marketing than with evidence-based medicine.  Wellness institutions and practitioners are omnipresent promising benefits that are often untested or rejected scientifically.   Hospitals that years ago would have shunned new age healing arts, now offer yoga, meditation, Reiki and massotherapy.  Do they do so because they have had a Damascus Road experience and now believe that these techniques are effective?  Guess again. Ahead of His Wellness Time? 100 Years Ago Metchnikoff Suggests Probiotics  Wellness is no longer restricted to medical campuses, costly weekend retreats for emotional and physical catharses and ubiquitous yoga storefronts.  Wellness is now championed by corporate America.   Business leaders argue that keeping employees well is not only a demonstration of good corporate citizenship, but is also good business.   Healthy employees, the