Comments on: Does Medicare secretly want pay for performance to fail? http://www.kevinmd.com/blog/2008/12/does-medicare-secretly-want-pay-for.html Tue, 14 Feb 2012 22:04:00 +0000 hourly 1 By: Anonymoushttp://www.kevinmd.com/blog/2008/12/does-medicare-secretly-want-pay-for.html#comment-88675 Anonymous Mon, 15 Dec 2008 23:32:00 +0000 http://clients.emmense.com/kevinmd/2008/12/does-medicare-secretly-want-pay-for-performance-to-fail.html#comment-88675 Few physician have any education in organizational psychology and sociology. Yet, given that we are no longer working autonomously, a lack of this knowledge leaves us helpless to defend our essential professionalism from those forces destroying it. Most often in our ignorance, we assist the forces of dissolution. Few physician have any education in organizational psychology and sociology. Yet, given that we are no longer working autonomously, a lack of this knowledge leaves us helpless to defend our essential professionalism from those forces destroying it. Most often in our ignorance, we assist the forces of dissolution.

]]> By: Anonymoushttp://www.kevinmd.com/blog/2008/12/does-medicare-secretly-want-pay-for.html#comment-88660 Anonymous Mon, 15 Dec 2008 15:48:00 +0000 http://clients.emmense.com/kevinmd/2008/12/does-medicare-secretly-want-pay-for-performance-to-fail.html#comment-88660 Anon 6:53 nailed it. I hope you're all paying attention. For a fuller explanation of this key political understanding, see Graham Allison's classic paper on the Cuban Missle Crisis. <br/><br/>Wikipedia gives a decent summary:<br/>http://en.wikipedia.org/wiki/Essence_of_Decision<br/><br/>It's having this nuanced perspective that separates the policy professionals from the policy amateurs. Here's to the professionals! Anon 6:53 nailed it. I hope you’re all paying attention. For a fuller explanation of this key political understanding, see Graham Allison’s classic paper on the Cuban Missle Crisis.

Wikipedia gives a decent summary:
http://en.wikipedia.org/wiki/Essence_of_Decision

It’s having this nuanced perspective that separates the policy professionals from the policy amateurs. Here’s to the professionals!

]]> By: Jon Slaterhttp://www.kevinmd.com/blog/2008/12/does-medicare-secretly-want-pay-for.html#comment-88652 Jon Slater Sun, 14 Dec 2008 23:55:00 +0000 http://clients.emmense.com/kevinmd/2008/12/does-medicare-secretly-want-pay-for-performance-to-fail.html#comment-88652 It should want P4P to fail. It's time for pay for outcomes It should want P4P to fail. It’s time for pay for outcomes

]]> By: Anonymoushttp://www.kevinmd.com/blog/2008/12/does-medicare-secretly-want-pay-for.html#comment-88651 Anonymous Sun, 14 Dec 2008 23:53:00 +0000 http://clients.emmense.com/kevinmd/2008/12/does-medicare-secretly-want-pay-for-performance-to-fail.html#comment-88651 Medicare has no intent. It is not an entity that possesses a unitary mind of any sort and is therefore incapable of the state of intent. This is not just linguistic nitpicking but is materially important in understanding healthcare bureaucracy and in managing it's impact on you. I work in the bureaucracy and find the end actions to be unrelated to any intent or scheme by higher management. Rather they are the net result of myriad disconnected unplanned processes the full interrelationships of which has never been studied, mapped or characterized in any way--they have just evolved. Competing subsystems clash with other susbsystems in ways that produce end actions that no one plans or intends. Medicare has no intent. It is not an entity that possesses a unitary mind of any sort and is therefore incapable of the state of intent. This is not just linguistic nitpicking but is materially important in understanding healthcare bureaucracy and in managing it’s impact on you. I work in the bureaucracy and find the end actions to be unrelated to any intent or scheme by higher management. Rather they are the net result of myriad disconnected unplanned processes the full interrelationships of which has never been studied, mapped or characterized in any way–they have just evolved. Competing subsystems clash with other susbsystems in ways that produce end actions that no one plans or intends.

]]>