Health care - administrative incompetence

[kellyb]

Sure I can, but I see little value in trading cheap shots about each other's strep throat guidelines. Talk about time wasters . . .

Surely you guys have a more substantial issue with my position than this?

I asked you to look at the NHS "care by age group" chart but you ignored me.

About strep throat guidelines, NICE etc openly say when a decision is being made out of cost. Do they say that about their strep throat guidelines? If not, why do you think they're keeping the cost factor a secret?

 

[Uncayimmy]

Sure I can, but I see little value in trading cheap shots about each other's strep throat guidelines. Talk about time wasters . . .

Surely you guys have a more substantial issue with my position than this?

Sounds to me like you were providing unnecessary tests. After all, you're the administrator, so you should know your stuff when you say that you test for strep for every sore throat. When called on it, you backpedaled and claimed it was only when the doc said it was necessary even though you had just proclaimed it "good medicine" to do so.

In a UHC system, I wouldn't even care because you would have no financial incentive to perform unnecessary tests. If someone complained, you could easily show something like the NHS guidelines so they understand why you made the choices you made.

Your business is not based on health outcomes but on profit. I'd much rather be treated by a doctor who has a reasonable income commensurate with his training training and education who then only has to worry about my well being. I'd feel a lot more confident that I was not getting unnecessary tests or not being given tests that could be helpful.

 

[xjx388]

So, does your clinic report statistical outcomes? If not, why not? Do you even track them? What's your flu vaccination rate? Breast cancer screening rate?

Insurance companies track our statistics using claims data We get letters from them suggesting ways we could be more efficient. We incorporate this into our practice when appropriate. As for Medicare/Medicaid, nothing like this happens. We could voluntarily participate in PQRI if we wanted to get an incentive payment, but we don't have the manpower to devote to this kind of stuff.

I would hope that under a UHC system clinics like that would be more strictly regulated when it comes to demonstrating results and using best practices. I don't like the idea of doctors rebranding supplements and selling them.

Ah, so you want all docs to be subject to demonstrating results and using best practices (as defined by who exactly?). And you want this to happen while reducing costs. I don't think so.

What we need is less regulation. In Bariatric medicine, it's a pretty free market. Good results = more patients. Same with Lasik and Cosmetic Surgery. If the Doc has bad results, word gets around and they go out of business. Docs have an incentive to practice good medicine to keep their practices alive.

 

[xjx388]

You were so sure it was a rationing, cost-saving, bad medical practice.

I still am.

It is a tad gleeful that are pursuing the issue, however, it is so rare that a single point is conceded, and the goalposts have shifted.

Huh?

 

[kellyb]

A *gasp* AMERICAN MD, on the US guidelines for sore throats:

http://www.entrepreneur.com/tradejournals/article/156551293.html

The justification for doing what we do is becoming slimmer and slimmer, so that the continued pursuit of group A streptococcal pharyngitis is really driven by an outdated notion of risk, and a self-perpetuated habit," he added.

 

[kellyb]

I still am.

If it was about cost and not science, why wouldn't they come right out and say so?

 

[xjx388]

Sounds to me like you were providing unnecessary tests. After all, you're the administrator, so you should know your stuff when you say that you test for strep for every sore throat. When called on it, you backpedaled and claimed it was only when the doc said it was necessary even though you had just proclaimed it "good medicine" to do so.

It is good medicine to test sore throats for strep. The fact is that most of the sore throats we see are kids that also come in with fever. The guidelines state to rapid test them and that's what we do. There are good medical reasons for doing so that have nothing to do with profit. Very few adults come in with sore throat and when they do it's pretty bad. So yeah, most of the sore throats we see get swabbed and it's good medicine, not profit-driven medicine. Notice that I said nothing about reimbursement. That's y'all's ideologies talking. The fact is we get reimbursed very little compared to the cost. Some insurances pay nothing. Big deal, it's a useful test.

We make a profit because patients choose to see us over other doctors. They choose to see us because 1)They like the doctor, 2)The doctor is very cost-conscious and controls the costs as much as possible, 3)The doctor practices good medicine; i.e. has good outcomes. If any of those factors was not present, we would not be in business.

In a UHC system, I wouldn't even care because you would have no financial incentive to perform unnecessary tests. If someone complained, you could easily show something like the NHS guidelines so they understand why you made the choices you made.

But you would care if we failed to perform a test and we missed something. You'd be cursing those guidelines in that case, I suspect.

Your business is not based on health outcomes but on profit.

You've got it backwards: We make a profit because we focus on outcomes.

I'd much rather be treated by a doctor who has a reasonable income commensurate with his training training and education who then only has to worry about my well being. I'd feel a lot more confident that I was not getting unnecessary tests or not being given tests that could be helpful.

My philosophy is very different from yours.

 

[Uncayimmy]

Insurance companies track our statistics using claims data We get letters from them suggesting ways we could be more efficient.

Efficient? You mean from a financial perspective? I'm talking medical outcomes.

Ah, so you want all docs to be subject to demonstrating results and using best practices (as defined by who exactly?). And you want this to happen while reducing costs. I don't think so.

The NHS does it. Right now there is virtually no financial incentive to improve outcomes in patients. There is incentive, however, for doctors to open weight loss clinics with gyms and rebrand unproven supplements.

What we need is less regulation. In Bariatric medicine, it's a pretty free market. Good results = more patients. Same with Lasik and Cosmetic Surgery. If the Doc has bad results, word gets around and they go out of business. Docs have an incentive to practice good medicine to keep their practices alive.

Good results equals more patients? ********. You have argued strenuously that the only long term solution for the morbidly obese is surgery, yet this place takes $300 up front and $150/month to give them diet and exercise programs. If people lose weight for a while, that's when the referralmight come. In two years, when they are back to being morbidly obese, which is what you claim happens, it's all for naught. Actually, it's worse. They will have wasted perhaps thousands of dollars and taken addictive and potentially dangerous drugs.

What are the long-term success rates for your patients? Do you even track them?

Having been involved in numerous businesses over the years, there are two basic paradigms. One approach is to build up a business through good service and referrals. Another is to market heavily and acquire new customers, which are in turn treated, well, let's just say "not so great." Both approaches work.

BTW, you snipped out what I wrote about doctors rebranding supplements and selling them. How do you feel about that? This place offered a sleep supplement, and there's virtually no evidence supporting their efficacy (and that includes melatonin).

 

[xjx388]

A *gasp* AMERICAN MD, on the US guidelines for sore throats:

http://www.entrepreneur.com/tradejournals/article/156551293.html

His are opinions are very interesting and have some validity. It's still just his opinion. One day the guidelines may change and so will practice. But there's more to it than just the medicine; you have to change the mindset of the patient. You guys are all skeptics. You can see the evidence and make a rational decision. Most people do not think this way. They go to a doctor and expect an antibiotic.

A rapid strep can be very useful in actually curbing antibiotic use. What our doc does is explain the reason we use antibiotics. She says that if the test is positive, we'll treat it, but if not we won't. Without that kind of objective test, most patients would insist on getting antibiotics. Heck, we live on the border so many patients that Doc refuses antibiotics to just go across the border and buy them in Mexico anyway. It's a cultural thing and that's hard to change.

 

[kellyb]

It is good medicine to test sore throats for strep. The fact is that most of the sore throats we see are kids that also come in with fever.

And probably other signs of a viral infection, too...

 

[kellyb]

His are opinions are very interesting and have some validity. It's still just his opinion. One day the guidelines may change and so will practice. But there's more to it than just the medicine; you have to change the mindset of the patient. You guys are all skeptics. You can see the evidence and make a rational decision. Most people do not think this way. They go to a doctor and expect an antibiotic.

A rapid strep can be very useful in actually curbing antibiotic use. What our doc does is explain the reason we use antibiotics. She says that if the test is positive, we'll treat it, but if not we won't. Without that kind of objective test, most patients would insist on getting antibiotics. Heck, we live on the border so many patients that Doc refuses antibiotics to just go across the border and buy them in Mexico anyway. It's a cultural thing and that's hard to change.

I'm just saying the "all those countries with less aggressive GAS testing are only less aggressive because they're trying to save money by performing inferior medicine!" argument is one you should probably concede.

UHC countries do ration care, but this isn't a valid example of it. How aggressive to be with GAS testing is a matter of genuine scientific debate.

 

[Mongrel]

ETA and further to Mongrel's post, you can also check drug prices in the BNF, given free to health professionals every six months and available at http://bnf.org/bnf/index.htm and downloadable on several sites. The current issue is 60, Sep 10. The paper one I have is 58 (Sep 09), my sister in law gave it to me.

If a drug isn't listed in the Tariff and is allowed for prescription, generally as long as it's not in the Black List (Part XV) and is licensed for use within the UK, then the price is whatever the pharmacist paid for it (upon inclusion of receipt). Whilst the BNF is a good guide, after a month or two it can become a little inaccurate (especially for Category M drugs and drugs that change category - see the DT for classifications)

This is the area that can be helped by free market forces as the big pharma supply companies jostle for being the cheapest supplier for the pharmacists - most pharmacies have one major supplier for the bulk of their stock and a handful more for particular lines, sundries and maybe Parallel Imports (PIs)

ETA: Sorry Agatha, I keep finding myself quoting your posts to clarify things a little more -it's not personal. I just see things from the pharmacists point of view (although not a pharmacist myself) and they should be a lot more aware of the drug pricing structures.

 

[xjx388]

Efficient? You mean from a financial perspective? I'm talking medical outcomes.

You know, this EBM crap y'all have been spewing? That. We get letters making EBM suggestions and Doc implements them when she feels it appropriate in individual cases.

The NHS does it. Right now there is virtually no financial incentive to improve outcomes in patients. There is incentive, however, for doctors to open weight loss clinics with gyms and rebrand unproven supplements.

I see what you are trying to do and it's entirely irrelevant to this thread.

The incentive is to keep your doors open and make a profit. You can't do that when your patients don't get better. And you have to make them better while keeping costs down. But the government programs don't reimburse enough to make a profit, so many docs respond by overutilizing tests and procedures. We avoid that problem by limiting the amount of government program patients we see.

Good results equals more patients? ********.

Really? So if a doctor gets good results he won't get more patients? Tell that to everyone trying to compete with MD Anderson for cancer care. Their reputation is for being the best in cancer treatment in the region. Patients will drive 6 hours to Houston when there are other good options in their local communities. But they have the reputation.

You have argued strenuously that the only long term solution for the morbidly obese is surgery, yet this place takes $300 up front and $150/month to give them diet and exercise programs. If people lose weight for a while, that's when the referralmight come. In two years, when they are back to being morbidly obese, which is what you claim happens, it's all for naught. Actually, it's worse. They will have wasted perhaps thousands of dollars and taken addictive and potentially dangerous drugs.

You have a very warped view of obesity treatment. But again, that's not really germane to the thread. Stick to the topic.

Having been involved in numerous businesses over the years, there are two basic paradigms. One approach is to build up a business through good service and referrals. Another is to market heavily and acquire new customers, which are in turn treated, well, let's just say "not so great." Both approaches work.

BTW, you snipped out what I wrote about doctors rebranding supplements and selling them. How do you feel about that? This place offered a sleep supplement, and there's virtually no evidence supporting their efficacy (and that includes melatonin).

I don't see any relevance to the thread in discussing the efficacy of sleep supplements. Start a new thread and maybe I'll debate you on that. Otherwise, you should stick to the thread topic.

As to the approaches to business, our clinic's model is to provide the best care that we possibly can keeping patient-centered focus. That's why we continue to grow and remain profitable.

 

[xjx388]

And probably other signs of a viral infection, too...

No. A fever is one of the reasons to do a strep test. No fever = less probability that it's strep.

 

[xjx388]

I'm just saying the "all those countries with less aggressive GAS testing are only less aggressive because they're trying to save money by performing inferior medicine!" argument is one you should probably concede.

UHC countries do ration care, but this isn't a valid example of it. How aggressive to be with GAS testing is a matter of genuine scientific debate.

I will concede this much: GAS testing is a matter of genuine debate and doesn't contribute much to the overall cost of health care either way. It's very minor.

 

[Uncayimmy]

It is good medicine to test sore throats for strep. The fact is that most of the sore throats we see are kids that also come in with fever. The guidelines state to rapid test them and that's what we do.

You said that you tested "every patient."

We make a profit because patients choose to see us over other doctors. They choose to see us because 1)They like the doctor, 2)The doctor is very cost-conscious and controls the costs as much as possible, 3)The doctor practices good medicine; i.e. has good outcomes. If any of those factors was not present, we would not be in business.

LOL! Right. You control costs by testing every patient with a sore throat for strep. And since your outcomes are not known, and you refuse to even answer questions about them, I highly doubt that's why you get these alleged referrals.

But you would care if we failed to perform a test and we missed something. You'd be cursing those guidelines in that case, I suspect.

Huh? I would be pissed if you followed the guidelines and in your clinical judgment decided not to do additional tests? Only if a group of medical professionals thought you were negligent.

You've got it backwards: We make a profit because we focus on outcomes.
My philosophy is very different from yours.

And just what are those outcomes? Do you track them? Publish them? What percentage of your patients are screened for breast cancer? Get flu vaccines? What are the results of your weight loss treatments at two years? Five years? What's your patient attrition rate?

 

[kellyb]

I will concede this much: GAS testing is a matter of genuine debate and doesn't contribute much to the overall cost of health care either way. It's very minor.

Fair enough.

Now would you like to go back to that "Medicare costs more per person than insurance does, so that shows that government is less efficient" argument?

 

[Rolfe]

The doctor is very cost-conscious and controls the costs as much as possible,

And you have to make them better while keeping costs down.

So, being cost-conscious and keeping costs down is great when it's Mrs. xjx388 doing it.

But when it's the NHS doing it, even though the example quoted is quite clearly being done in order to follow modern evidence-based best practice which Mrs. xjx388 hasn't caught up with yet, it's evil denial of care.

And xjx388 still didn't acknowledge that if the antibiotics he thinks should be prescribed (and never mind the increasing problem of antibiotic resistance) were indeed prescribed, the prescription tax (England) of £7.50 would be a clear winner over the actual cost of the antibiotics (about £2.50).

Meh. xjx388 is clearly deeply in love with the US system, and never mind Ducky and kellyB and bookitty's MiL and all the other people being screwed over by it. He says it's a mess and has to change, but in fact he'll defend it with his last breath, and nothing will ever persuade him to see any merit in any system that covers everyone free at the point of delivery.

What a waste of time.

And by the way, can I nominate Tatyana for Queen?

Rolfe.

 

[Uncayimmy]

You know, this EBM crap y'all have been spewing? That. We get letters making EBM suggestions and Doc implements them when she feels it appropriate in individual cases.

Such as?

I see what you are trying to do and it's entirely irrelevant to this thread.

Hand waving noted.

The incentive is to keep your doors open and make a profit. You can't do that when your patients don't get better.

Sure you can! I have no way of knowing how good my doctor is short of my personal experience and look at public records. Beyond that, it's a crap shoot.

And you have to make them better while keeping costs down. But the government programs don't reimburse enough to make a profit, so many docs respond by overutilizing tests and procedures. We avoid that problem by limiting the amount of government program patients we see.

So, you admit then that you overutilized by testing for strep in every case of sore throat?

Really? So if a doctor gets good results he won't get more patients?

How would I know? I mean, other than really obvious stuff like plastic surgeons, who really knows how good anybody is? How can I find out how good you are?

You have a very warped view of obesity treatment. But again, that's not really germane to the thread. Stick to the topic.

It's actually quite germane. That clinic where you live seems mostly focused on making a profit. Once again, how do you feel about doctors rebranding supplements and opening a gym/dance studio as part of their practice? As for my opinions about how to treat obesity, this clinic violates the standards that you personally put forth regarding obesity. Based on the one client I actually found, it looks like they went straight to a drug that is banned in some countries rather than waiting to see what kind of results the person got otherwise.

This ties into the profit motive. You see, it can take a lot of effort to lose weight. What better way to get people to stick with a $150/month program than to give them an appetite suppressant? You get quick results, which keeps them coming back. Then you get some quick referrals. That's not patient-centered - that's profit centered.

I don't see any relevance to the thread in discussing the efficacy of sleep supplements. Start a new thread and maybe I'll debate you on that. Otherwise, you should stick to the thread topic.

Again, how do you feel about a doctor's office rebranding supplements and selling them? It's bad enough we have this crap in the supermarket, but do you really think doctor's should be selling the stuff?

As to the approaches to business, our clinic's model is to provide the best care that we possibly can keeping patient-centered focus. That's why we continue to grow and remain profitable.

Funny. You call it patient centered focus, but you spend most of your time yapping about insurance companies and how you limit Medicare patients. Did you learn about how to deal with insurance companies when you were in med school? Was that part of your curriculum?

 

[kellyb]

The incentive is to keep your doors open and make a profit. You can't do that when your patients don't get better.

Sure you can! I have no way of knowing how good my doctor is short of my personal experience and look at public records. Beyond that, it's a crap shoot.

Hell, homeopaths make a killing. From the same patients, over and over again. sCAM is a multiBILLION dollar industry in the US.