In "Why 'Quality' Care is Dangerous" Jerome Groopman, MD complains the definition of 'quality' is too narrow, eg: only 'quality' that conforms to consensus standards set by Medicare experts is of sufficient 'quality'.
Consensus means measurement of simple clinical procedures that fail to capture the complexity of medical decision-making, such as diabetic management.
But 'quality' in P4P is meant to capture under-treated aspects of big, high-cost drivers in medicine, like why do so many people suffer from lower back pain (LBP)?
For example, pain is the number one reason people go to see a doctor. A simple zero-to-ten pain scale is more sensitive to clinical change than a comprehensive pain questionnaire yet pain is assessed in less than 50% of the clinical encounters in America.
Why?
One P4P quality metric for physical therapists is pain assessment and implementing a plan of care to treat pain.
Lower back pain has passed cancer spending in research dollars and, prior to 2006, small-dollar, high-volume CPT codes for therapeutic spine treatments were growing at over 35% per year.
Another simple problem in medicine:
Why are so many Americans obese?
Obesity, not disease, is the primary driver of disability in America.
Another quality metric for physical therapists is assessment of body mass index.
While Dr. Groopman could, no doubt, cite examples of complexity in medical decision-making involving LBP and obesity the vast majority of these cases are simple diagnoses that relate to lifestyle factors, not exotic diseases.
There's that old saw in medicine: "When you hear hoof beats, think horses - not zebras"
Show Me the Money!
The biggest, costliest health problems in America are not rare diagnoses - the costliest problems are the result of daily choices we make about diet and exercise.
Dr. Groopman is right, P4P simplifies the collection of basic data which may interfere with complex physician and physical therapist decision-making.
But, it's not the complex decisions American doctors needs help with...
We need help with the simple decisions.
Home »
Medicare »
p4p »
physcal therapists »
physical therapist decision-making »
PQRI »
Why 'Quality' Care is Inevitable
Senin, 20 April 2009
Why 'Quality' Care is Inevitable
Artikel Terkait Why 'Quality' Care is Inevitable :
Should Physical Therapists Abandon Direct Access? Vote 'No' on #APTArc20A recent proposed motion in front of the American Physical Therapy Association (APTA) House of Delegates threatens to overturn 40 ...
Medicare Uses "Inaccurate and Inconsistent Data" to Audit ProvidersThe Washington Post reported today that..."Medicare contractors are paid tens of millions of taxpayer dollars to detect fraudulen ...
Will Your Physical Therapy Clinic Close by 2020?Why One-Third of Hospitals Will Close By 2020, written by by David Houle and Jonathan Fleece, JD, on the KevinMD website is a tho ...
Telehealth Potential Remains, Trapped by Regulations and Licensure BarriersDr. Alan Lee's Perspective article in the December 2011 Physical Therapy journal offers hope tempered with a dose of pragmatic re ...
Doc Fix will affect physical therapists, tooWe done this three times already in 2010 but the 21.29% cut in the Medicare Physicians' Fee Schedule is again scheduled to go int ...
Langganan:
Posting Komentar (Atom)
0 komentar:
Posting Komentar