Beware how the affect heuristic filters your view of data
The Spock in us would like to see data as hard, fixed, and totally interpretable. The Dr. McCoy in us understands that data do not have those properties. Nietzsche once wrote, “There are no facts, only interpretations”
In fact we always interpret “facts” in light of our biases. Our filters come from our preconceived opinions. If we like something, we give great value to “data” that support that belief, while we de-emphasize the negative findings. Vice versa works also.
When you watch the debate, if you like Hiliary Clinton you will cheer her pronouncements and believe them true...
Source: DB's Medical Rants - September 26, 2016 Category: Internal Medicine Authors: rcentor Tags: Medical Rants Source Type: blogs
Calculating Shared Savings: Administrative Formulas Versus Research-Based Evaluations
Shared savings lie at the core of many recent health care payment and delivery reforms, most prominently those involving accountable care organizations (ACOs). The distribution of savings between payers and providers depends crucially on the establishment of whether savings were generated by new provider activities, and if so, the magnitude of such savings. Two approaches to savings assessment are commonly applied: 1) administrative formulas and 2) research-based evaluation.
While the two approaches are related, they use very different methods to achieve different goals. Although the main conclusions often overlap, there a...
Source: Health Affairs Blog - September 26, 2016 Category: Health Management Authors: Derek DeLia Tags: Costs and Spending Health Professionals Payment Policy Comprehensive Primary Care demonstration difference-in-differences analysis Medicare Shared Savings Program Research Source Type: blogs
Service Innovation
“Shift the business models”
“Re-align the incentives”
“Fee-for-value”
These phrases are not new.
Nor are the concepts they represent.
Yet we’re starting to see new experiments from the federal government, from states, and even small communities that demonstrate a new willingness to deeply engage in understanding and overcoming the barriers to true change in how we improve health.
Notice that I said “improve health.” I didn’t say “Improve health care.” This not just an insignificant semantic nuance. When we conflate care and health, we accept the fundamentally flawed assumption that in order fo...
Source: Docnotes - September 16, 2016 Category: Primary Care Authors: Jacobr Tags: Uncategorized Value Source Type: blogs
Service Innovation
?Shift the business models?
?Re-align the incentives?
?Fee-for-value?
These phrases are not new.
Nor are the concepts they represent.
Yet we?re starting to see new experiments from the federal government, from states, and even small communities that demonstrate a new willingness to deeply engage in understanding and overcoming the barriers to true change in how we improve health.
Notice that I said ?improve health.?? I didn?t say ?Improve health care.?? This not just an insignificant semantic nuance.? When we conflate care and health, we accept the fundamentally flawed assumption that in order for people to be healthy, we ...
Source: Docnotes - September 16, 2016 Category: Primary Care Authors: Jacobr Tags: Uncategorized Value Source Type: blogs
Pain Care As A Catalyst For Primary Care Transformation
As part of our mission to improve New Jersey’s health care delivery systems and reduce the costs of care for its underserved populations, The Nicholson Foundation has been working to strengthen primary care in the state’s safety-net system. Central to this effort is support for the integration of behavioral health care (substance use and mental health treatment) into primary care settings.
With the explosion of the prescription opioid crisis in the past several years, and the concomitant awareness of the role of primary care providers in inadvertently contributing to it, this integration work has become urgent and esse...
Source: Health Affairs Blog - September 8, 2016 Category: Health Management Authors: Joan Randell and Raquel Mazon Jeffers Tags: Drugs and Medical Technology GrantWatch Health Professionals Behavioral Health chronic pain Consumers Health Philanthropy New Jersey opioids pain management Primary Care Project ECHO Safety Net States substance use Source Type: blogs
Direct primary care – understand the appeal before your criticize
ACP has an excellent position paper on direct primary care – Assessing the Patient Care Implications of “Concierge” and Other Direct Patient Contracting Practices: A Policy Position Paper From the American College of Physicians
Martin Donohoe, MD in a letter criticizing the paper Academic Medicine and Concierge Practice makes what I consider the tired, holier than thou, ethical argument that such practices are in fact not ethical. He writes,
For such institutions to teach students to treat all patients equally, combat inequalities in health care access and outcomes, and practice evidence-based medicine while...
Source: DB's Medical Rants - September 6, 2016 Category: Internal Medicine Authors: rcentor Tags: Medical Rants Source Type: blogs
Direct primary care physicians are trying to rescue other doctors
In a recent interview, Dr. Farzad Mostashari (former national coordinator for health IT and current CEO, Aledade ACO) gave some advice to physicians on how to avoid burnout and “restore their role as caregivers”:
The key is two things. One, if you’re in a kayak in the rapids, you have to lean in and dig your paddle in and push ahead. If you lean back, you’re done. You’re going to flip over. So be more active. Don’t be passive. Take control. Step two is join together with others to increase your power, increase your control, increase your ability to have someone else help you deal with that crap,...
Source: Kevin, M.D. - Medical Weblog - September 2, 2016 Category: Journals (General) Authors: < a href="http://www.kevinmd.com/blog/post-author/w-ryan-neuhofel" rel="tag" > W. Ryan Neuhofel, DO, MPH < /a > Tags: Physician Primary care Source Type: blogs
Demand For Family Medicine Physicians Ranks Highest Among Specialties
Discussion
While indicated in only one instance from one state, the rise of family medicine to the specialty with the greatest demand among New York State trainees is a very positive development. The ranking is somewhat surprising given that primary care advocates have been calling for greater support for several decades with little response. It is worth noting that New York State has not been known to be particularly friendly to family medicine residency training. For many years, few of the state’s academic medical centers even offered family medicine training, making this an even more noteworthy development. For examp...
Source: Health Affairs Blog - August 18, 2016 Category: Health Management Authors: Edward Salsberg, David Armstrong and Gaetano Forte Tags: Featured Health Professionals Hospitals family medicine Graduate medical education New York Physicians Primary Care Source Type: blogs
The Bright Future of Pharmacies
The rapid development of medical technology affects every aspect of medicine and healthcare – and even the seemingly most remote and ivory-tower-like institution, pharmacy, cannot escape its transformative power. Let me show you the bright future of pharmacies.
Although pharmacies play a key role in the healing process, the impression of patients about pharmacists and their drug store is often that they offer a type of commercial/business-like service. The doctor prescribes the appropriate medicine with the appropriate instructions, and the pharmacist provides it in exchange for money. A clear business.
However, as the...
Source: The Medical Futurist - August 17, 2016 Category: Information Technology Authors: nora Tags: Future of Medicine Future of Pharma 3d printing gc4 Healthcare Personalized medicine pharmacies Source Type: blogs
What economic theory can teach physicians about retail clinics
As clinicians continue to debate the merits and limitations of retail clinics, it is increasingly clear that they are here to stay. These nontraditional sites have proliferated around the country, appealing directly to patients’ desires for convenience in ways that many traditional primary care practices do not. A report by the Robert Wood Johnson Foundation found that retail clinics have increased by 900 percent over the last decade, an expansion that represented 10.5 million patient visits in 2012.
Although some concerns about this trend have merit, retail clinics could also create positive disruption for the medic...
Source: Kevin, M.D. - Medical Weblog - August 11, 2016 Category: Journals (General) Authors: < a href="http://www.kevinmd.com/blog/post-author/kyle-morawski-and-joshua-liao" rel="tag" > Kyle Morawski, MD and Joshua Liao, MD < /a > Tags: Policy Primary care Source Type: blogs
Are CMS ’s “Medical Homes” Underfunded or Unfocused?
By KIP SULLIVAN
“[We are supposed to gather information from patients] prior to the physician going into the room. It doesn’t happen. I’m going to be honest – the reality … is … we also are responsible for telephone triage, walk-in emergencies, diabetic meter teaching, I mean, the list goes on and on.” (Brackets in the original)
That is a quote from an interview with a “care coordinator” for a “medical home” in Minnesota. Minnesota is one of the eight states that participated in the Multi-Payer Advanced Primary Care Practice (MAPCP) Demonstration, which is one of three experiments CMS has cond...
Source: The Health Care Blog - August 3, 2016 Category: Consumer Health News Authors: John Irvine Tags: Uncategorized Source Type: blogs
CMS Launches CPC + Multipayer Regions: Applications Process Opens to Practices
By GREG FULTON
Amid growing consensus that MACRA may delay from its 2017 performance year start, CMS is moving ahead with next year’s launch of the Comprehensive Primary Care Plus (CPC+) program.
Fourteen multi-payer regions and all participating payers were announced August 1, (listed below) and practices can now begin applying through September 15. CMS has launched an application portal for practices.
CPC+ is part of MACRA, as one of six Advanced Alternative Payment Models, but certainly can be undertaken on its own. CMS has a deadline of November 1 to produce a MACRA final rule, but can announce MACRA’s fate anytime...
Source: The Health Care Blog - August 3, 2016 Category: Consumer Health News Authors: John Irvine Tags: Uncategorized ACO CPC MSSP Source Type: blogs
CMS Comprehensive Primary Care Plus Initiative CPC+
CMS wants to pay practices a monthly fee to manage care for as many as 25 million patients in the agency's largest-ever plan to transform and improve how primary care is delivered and reimbursed. The Comprehensive Primary Care Plus (CPC+) initiative will be implemented in up to 20 regions and include up to 5,000 practices, which would encompass more than 20,000 doctors and clinicians. The program would collaborate with commercial, state, and other federal insurance plans. Since April 15, CMS has started to solicit payer proposals to partner in CPC. From there, CMS will solicit applications from nearby practices. This solic...
Source: Policy and Medicine - August 2, 2016 Category: American Health Authors: Thomas Sullivan - Policy & Medicine Writing Staff Source Type: blogs
CMS ’s Latest Report Is Bad News For Medical Homes
Conclusion
RTI should never have promised CMS and its readers it would identify factors associated with “outcomes,” improved or otherwise. The definition of the PCMH offered by leading “home” advocates is flabby enough. Trying to test such a wobbly concept in eight states when each state is allowed to use a different definition is just a wild goose chase.
Is there anything at all we can learn from such a poorly designed experiment? I’ll attempt to answer that question in subsequent comments.
[1] A bizarre feature of this report is the use of two control groups. RTI, perhaps at CMS’s insistence, set up one contr...
Source: The Health Care Blog - July 30, 2016 Category: Consumer Health News Authors: John Irvine Tags: Uncategorized CMS Source Type: blogs
Flu Shot May Help Protect Diabetics From CV Hospitalization
This study shows that it may significantly reduce cardiovascular illness and death during flu season, and thus it is very important for this high-risk population to get vaccinated, she stressed. < /p > < p > Dr Jacob A Udell (Peter Munk Cardiac Centre and Cardiovascular Division, University Health Network, and University of Toronto, ON), who was not involved with this study, agrees. These observational data provide " positive reinforcement of why we should be getting patients vaccinated, particularly patients who aren ' t over 65 but have diabetes, " he told < b > heart < em > wire < /em > < /b > . < /p > < p > Before flu...
Source: Dr Portnay - July 26, 2016 Category: Cardiology Authors: Dr Portnay Source Type: blogs
