AHRQ newest Fraud: "Lean" and "Six Sigma"

[DrCommonSense]

Its good that the Republicans want to defund AHRQ.

As stated before, the name of the game for the "efficiency" groups is to ADD "consultants" to "save money" by either firing staff, performing less procedures, doing less for the patients without quality improvements, etc.

In THEORY, they are supposed to "improve quality and costs" through their brilliant studies and implementation processes that would streamline medicine.

Guys like Rodger Chou would be paid millions in "consultant fees" to find "savings" in the bloated system.

Lets see how thats worked in Canada:

http://www.cbc.ca/news/canada/saskatoon/new-report-final-straw-for-lean-ndp-says-1.3429291

http://www.theglobeandmail.com/news...ittle-impact-on-patient-care/article17561357/

Apparently, NO SO WELL right?

But it gets better. These "consultants" like Chou who are going to "hold everyone accountable" for "efficiency" don't like to get held accountable themselves.

Interesting how these "consultants" don't want their salaries/bonuses tied to actual savings they bring to the system:

http://www.leanblog.org/2014/03/is-...ultant-based-on-a-percentage-of-cost-savings/



So the true name of the game is thus:

http://nupge.ca/content/11536/spending-40-million-consultants-odd-way-save-money

Now you get the idea.

AHRQ= consultant fraud group that is peddling "efficiency" while INCREASING costs with decreased quality of care and POCKETING the moneys saved by laying off staff.

Like I said, the Republicans are right.

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[Fan_of_Meehl]

One of the most despicable developments that has been, unfortunately, booming in the past couple of decades is the rise of the non-degreed, non-practicing, non-professional (i.e., in the clinical sense) 'expertologist' or 'excellentologist' who learns a couple of basic statistical procedures from an undergrad curriculum (as part of a 'black-belt' training curriculum for LEAN / six sigma) and proceeds to get into a position of authority/control over a clinical program comprised of educated, experienced, and sophisticated practitioners.

Not all 'outcomes' can be measured validly with simple metrics or single numbers.

The practice of medicine (or psychology, or any other clinical profession for that matter) is not reducible to a single (or a few) quatifiable 'metrics' that are context-independent.

I'm sure the paradigm works fine for churning out reliably dimensioned machined car parts (at Toyota) and other highly determined and convergent tasks. I have yet to encounter a reliable, valid, context-independent method for reducing the complex tasks involved in clinical care to a single or a few numeric parameters.

 

[DrCommonSense]

One of the most despicable developments that has been, unfortunately, booming in the past couple of decades is the rise of the non-degreed, non-practicing, non-professional (i.e., in the clinical sense) 'expertologist' or 'excellentologist' who learns a couple of basic statistical procedures from an undergrad curriculum (as part of a 'black-belt' training curriculum for LEAN / six sigma) and proceeds to get into a position of authority/control over a clinical program comprised of educated, experienced, and sophisticated practitioners.

Not all 'outcomes' can be measured validly with simple metrics or single numbers.

The practice of medicine (or psychology, or any other clinical profession for that matter) is not reducible to a single (or a few) quatifiable 'metrics' that are context-independent.

I'm sure the paradigm works fine for churning out reliably dimensioned machined car parts (at Toyota) and other highly determined and convergent tasks. I have yet to encounter a reliable, valid, context-independent method for reducing the complex tasks involved in clinical care to a single or a few numeric parameters.

Great argument and very valid.

Its quite disturbing to see non physicians or marginal "research" physicians who really dont practice in the real world (ex Chou) who are largely just paid off to cut services as being "efficient" while increasing "consultant fees" and overhead dramatically.

In the end, this "efficiency" is useless crap because they charge far more money than they save in "costs". Furthermore, they just push the costs downstream to the ERs that have to handle the influx of Medicaid patients that will get increased imaging, testing, etc that will cost far more than it saves.

A perfect example of these jokers was when they implemented this garbage in Canada. They cost 1,511 for every dollar they saved after an Audit:

http://www.cbc.ca/news/canada/saskatoon/new-report-final-straw-for-lean-ndp-says-1.3429291

Chou is another form of this type of scam artist masquerading as a physician.

Also, these clowns never want to get paid a percentage of these supposed savings either instead of huge fees with no accountability : http://www.leanblog.org/2014/03/is-...ultant-based-on-a-percentage-of-cost-savings/


Usually, these jokers have no clinical experience in the real world and are mostly MBA/MPH "consultants" that know very simple statistical methods and make pretty ppt presentations that offer nothing practical for the system in terms of cost savings.

 

[Fan_of_Meehl]

Great argument and very valid.

Its quite disturbing to see non physicians or marginal "research" physicians who really dont practice in the real world (ex Chou) who are largely just paid off to cut services as being "efficient" while increasing "consultant fees" and overhead dramatically.

In the end, this "efficiency" is useless crap because they charge far more money than they save in "costs". Furthermore, they just push the costs downstream to the ERs that have to handle the influx of Medicaid patients that will get increased imaging, testing, etc that will cost far more than it saves.

A perfect example of these jokers was when they implemented this garbage in Canada. They cost 1,511 for every dollar they saved after an Audit:

http://www.cbc.ca/news/canada/saskatoon/new-report-final-straw-for-lean-ndp-says-1.3429291

Chou is another form of this type of scam artist masquerading as a physician.

Also, these clowns never want to get paid a percentage of these supposed savings either instead of huge fees with no accountability : http://www.leanblog.org/2014/03/is-...ultant-based-on-a-percentage-of-cost-savings/


Usually, these jokers have no clinical experience in the real world and are mostly MBA/MHA "consultants" that know very simple statistical methods and make pretty ppt presentations that offer nothing practical for the system in terms of cost savings.

Those jokers from outside the field are obviously unqualified to be judging anything about the 'quality' or 'efficiency' of medical care delivered by qualified providers who actually understand the issues pertaining to 'quality' in the delivery of medical care.

And anyone who actually has a professional degree in an applied field and who specializes in 'quality improvement' is generally a talentless hack who also lacks moral integrity. Either they're so clueless as to not actually realize that they are oversimplifying the problem (generally rare in someone with an advanced degree in the field, but it happens) or they realize (and don't care) that they're capitalizing on others' (non-professionals) ignorance regarding the complexity of care delivery in the field and they are cynically and systematically ignoring this in order to garner esteem, privilege, and money that their mediocre talents/knowledge in the field would not otherwise afford them.

The over-quantification (and insistence on quantitative analysis being the be-all, end-all) of complex medical care delivery is a prototypical example of 'too much of a good thing.' Sure, if we NEVER try to quantify things or look at the numbers, that would be bad. And if we ALWAYS judge everything in terms of the numbers, well, that's bad too. Lot's of folks don't get that quantitative analysis has its place, but it should also be kept in its place, as well.

I have yet to meet a single practitioner in my field (clinical psychology) whose primary identity involved any kind of 'quality improvement' or 'excellence in care' who was anything more than a self-aggrandizing, mediocre (or worse), talentless hack who just wanted to climb the ladder and gain influence over everyone else. As you aptly noted, these types don't appreciate their tools being turned to focus on their own performance.

The best clinicians in my experience are far too preoccupied with trying to apply effective methods to the patients in their own caseloads to be motivated to bother with trying to tell everyone else how to practice or how to achieve 'quality improvement.' The best clinicians also don't tend to have to force their opinions on others...their opinions are often solicited by others in a voluntary manner ('Dr. X, how do you get such good results with your patients? I'd like to know more').

Unsolicited advice is the junk mail of life...including professional life.