Comments on: Medical waste http://www.kevinmd.com/blog/2008/10/medical-waste.html medical blog Sun, 22 Nov 2009 14:15:05 -0500 http://wordpress.org/?v=2.8.4 hourly 1 By: The Refugee http://www.kevinmd.com/blog/2008/10/medical-waste.html/comment-page-1#comment-87771 The Refugee Sat, 25 Oct 2008 22:25:00 +0000 http://clients.emmense.com/kevinmd/2008/10/medical-waste.html#comment-87771 You get too crazy about outcomes and you screw over the docs in the inner city and rural areas where patient compliance is worse.<br/><br/>At some point, society is going to have to place some trust back into the doctor's hands. You get too crazy about outcomes and you screw over the docs in the inner city and rural areas where patient compliance is worse.

At some point, society is going to have to place some trust back into the doctor’s hands.

]]> By: Deron S. http://www.kevinmd.com/blog/2008/10/medical-waste.html/comment-page-1#comment-87767 Deron S. Sat, 25 Oct 2008 14:30:00 +0000 http://clients.emmense.com/kevinmd/2008/10/medical-waste.html#comment-87767 On paper, paying based on outcomes sounds great. I'm just not sure how that could be structured without adding more complexity to an already complex system. I'm not convinced that we need to abandon the fee for service model. A good compromise might be to review outcomes on an annual basis when fee schedule negotiations take place. A practice with good outcome and utilization ratios compared to peers gets a bigger increase to its fee schedule. Of course, this assumes that we're also going to simultaneously tackle the factors that are causing defensive medicine, as well as realign the RVU system to place more value on primary care. On paper, paying based on outcomes sounds great. I’m just not sure how that could be structured without adding more complexity to an already complex system. I’m not convinced that we need to abandon the fee for service model. A good compromise might be to review outcomes on an annual basis when fee schedule negotiations take place. A practice with good outcome and utilization ratios compared to peers gets a bigger increase to its fee schedule. Of course, this assumes that we’re also going to simultaneously tackle the factors that are causing defensive medicine, as well as realign the RVU system to place more value on primary care.

]]> By: Anonymous http://www.kevinmd.com/blog/2008/10/medical-waste.html/comment-page-1#comment-87766 Anonymous Sat, 25 Oct 2008 14:27:00 +0000 http://clients.emmense.com/kevinmd/2008/10/medical-waste.html#comment-87766 Have you run across any research regarding excess costs due to inefficiencies in the system? For instance, I once had a patient stay in the hospital an extra 4 days because he didn't have a pair of shoes to go home in. The only reason he left at all was because we all chipped in to buy him a pair!<br/><br/>Another area of waste is the CYA mentality; I'm sure hundreds of thousands of unnecessary CT scans are done every year just to prevent missing something very rare. Have you run across any research regarding excess costs due to inefficiencies in the system? For instance, I once had a patient stay in the hospital an extra 4 days because he didn’t have a pair of shoes to go home in. The only reason he left at all was because we all chipped in to buy him a pair!

Another area of waste is the CYA mentality; I’m sure hundreds of thousands of unnecessary CT scans are done every year just to prevent missing something very rare.

]]>