Am I crazy for not supporting this? (AAMC residency petition)

[PL198]

I think you misunderstood my point. The reimbursement isn't by each individual patient's outcome. It is for the overall outcome of patients with a specific condition who receive a specific treatment. For a system like this the reimbursements would be bundled and would take into account all of your patient outcomes. All providers will face difficult patients who don't comply with their advice so it isn't specific to any single provider. However, those providers who found ways to deal with these difficult patients (instead of just disregarding them) would be rewarded!

Right, so doctors who tell patients to lose weight, stop drinking, stop smoking and to exercise, when their entire population of patients fails to do so, then you punish them. There's no way to deal with them. You shouldn't have to jump through hoops to convince someone to take their own health seriously. If I don't study for my exams, I don't have a babysitter to tap my shoulder and say " you really need to do more," so why in the world would medicine be like that? It's removing the autonomy of the patients, because you're saying the physician needs to be more active for the patient to do what is recommended. No, I think they're perfectly capable, they just don't want to.[/QUOTE]

lol that is a bit of an exaggeration. Most patients actually care about their health contrary to your believe. Like I said every provider has to face this problem. So this problem will be accounted for.[/QUOTE]

alright then why is the obesity rate in america ~32 percent and then if you combine obesity and overweight it's roughly 70 %. there's a reason behind US doctors being just as good as the doctors in other nation, yet our obesity rate being much higher than other developed nations. that reason has nothing to do with physicians. junk in, junk out.

Inb4 you blame it on fast food or societal pressure or something completely unrelated.

people care about their health acutely. you tell someone they're having a heart attack and they freak out. you tell them it's inevitable they will have a heart attack in 5 years, they shrug it off.

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[ASD2019]

Ok let's say the majority of patients are noncompliant careless fat ***es. How does that change anything? Everyone has to deal with it? Everyone's numbers would be affected by it. And even better it would reward those who found better ways to manage these fat***es!

 

[Doudline]

Right, so doctors who tell patients to lose weight, stop drinking, stop smoking and to exercise, when their entire population of patients fails to do so, then you punish them. There's no way to deal with them. You shouldn't have to jump through hoops to convince someone to take their own health seriously. If I don't study for my exams, I don't have a babysitter to tap my shoulder and say " you really need to do more," so why in the world would medicine be like that? It's removing the autonomy of the patients, because you're saying the physician needs to be more active for the patient to do what is recommended. No, I think they're perfectly capable, they just don't want to.

What happens if you fail all your classes - do you just dissapear into space & time with no one noticing?
No. You'll get called into X's office, be told to put more efforts, be offered tutoring/counselling/study methods etc.

And if it keeps going, someone will have you do remediation, perhaps even retake a year or two or ten, because really medical students are the most cuddled students of any educational program in the country. Administration will cover your ass until nothing can be done anymore.

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Besides, you're legit ignorant.

Government research has shown that over 20% of the population cannot comprehend the most basic forms of written work (alphabetized but illiterate). How should these people get their health information - the TV news? Oprah? They CANNOT read books/Internet pages about healthy eating, about the side effects of alcohol/tobacco/other drugs, about weight loss. Just THINK a second about how you would struggle to find ANY information if you couldn't read and weren't scholarized.

Health professionals are often the sole source of credible information for these people. You can't assume that everyone has the info only because you do. You're not infringing on anyone's autonomy by counselling them on healthy habits - you're just doing your God damned job honey.

 

[PL198]

yeah because it takes reading to understand if you eat a bunch of high calorie food without burning lots of calories that you'll end up fat.. the uneducated excuse is so stupid. well they can't read the sign that says bathroom but I don't see them needing diapers. The info is there if you observe it. the layman doesn't need scientific understanding of the concepts to take advantage of them. I don't have to recognize the magnitude of gravity to not fall off the earth.

 

[PL198]

show me research where education made an impact. everyone always touts the education, yet I've never seen anything about its efficacy. please don't show me a link between obesity rates and education level or I won't take you seriously. show me a study where they took people, educated them and then noticed results

my job isn't to be someone's babysitter. I'm fine with saying " hey you're 120 lbs overweight, this puts you at an increased risk for XYZ, here's what I'd like to see you do." After that they can ask questions, but if they fail, it's not on me.

 

[ASD2019]

How can you measure outcomes? Let's say you're a cancer doctor and your outcomes are defined as length of life after diagnosis. You send all your hard cases to MD Anderson so your numbers look good and their cancer doctors' numbers look bad. They spent a lot more time and effort on their patients but their patients live shorter lives because they are more difficult cases. So should the MD Anderson doctors be penalized for their poorer outcomes?

Actually we were talking about large integrated practice groups. These groups would have all of the necessary doctors and specialist required to treat their patients without needing to refer them. One of the main points is to minimize fragmented referrals to outside providers. The group would get reimbursed as a group. So your hypothetical scenario would be almost unheard of if large groups like these became prevalent.

 

[BestDoctorEver]

@Doudline @ASD2019 It's not that easy to convince people to change their lifestyle... I worked in healthcare for 7 years as a RN and many times I had COPD patients that had trouble breathing, you give them their meds, they get better and then 15 minutes later they grab their cigarettes and start smoking... Do I want insurance companies or government bureaucrats to measure outcomes using patients like those? These are not isolated cases, they are common...Those stuff usually look good in sound bites, but when it's time to implement them, you realize they don't make that much sense...

 

[Baller MD]

Nvm​

 

[PL198]

Actually we were talking about large integrated practice groups. These groups would have all of the necessary doctors and specialist required to treat their patients without needing to refer them. One of the main points is to minimize fragmented referrals to outside providers. The group would get reimbursed as a group. So your hypothetical scenario would be almost unheard of if large groups like these became prevalent.

what are you talking about? you realize this is a little more complex than a binary system of does/does not have access to adequate health care providers? are you seriously that naive? if so, I've got some oceanfront property in OK to sell you

 

[Baller MD]

what are you talking about? you realize this is a little more complex than a binary system of does/does not have access to adequate health care providers? are you seriously that naive? if so, I've got some oceanfront property in OK to sell you

It seems that he hasn't started medical school yet.

 

[PL198]

also yeah we should totally compensate people as groups. a FM doc getting paid as much as a GI doc would totally go over well. holy disconnect from the real world

 

[BestDoctorEver]

also yeah we should totally compensate people as groups. a FM doc getting paid as much as a GI doc would totally go over well. holy disconnect from the real world

I am sure he/she already realizes how difficult it is to implement these measures... These stuff always sound good, but not easy to implement ...

 

[jw3600]

Y'all mother f-ers need to learn how to quote properly. Way to hard to follow any of the most recent string of posts.

 

[ASD2019]

@Doudline @ASD2019 It's not that easy to convince people to change their lifestyle... I worked in healthcare for 7 years as a RN and many times I had COPD patients that had trouble breathing, you give them their meds, they get better and then 15 minutes later they grab their cigarettes and start smoking... Do I want insurances companies or government bureaucrats to measure outcomes using patients like those? These are not isolated cases, they are common...Those stuff usually look good in sound bites, but when it's time to implement them, you realize they don't make that much sense...

I'm not saying it is easy. My argument actually had nothing to do with compliance. My point is that these non-compliant patients are widespread in the system and not isolated to a few providers. Every provider has to deal with them. So comparing one provider's outcome to another already takes these patients into account. I am not advocating for government mandates that set "standards" for what is an acceptable outcome. I'm advocating for a "more" free market where competition for better patient outcomes between providers is the driving force. Providers would find better ways to solve the problems they face not because they have to meet some minimum standards, but because they will be forced to close shop if they don't!

Your argument is like saying - no salesman shall be commissioned simply because there are grouchy/rude customers out there. Of course there are plenty of unpleasant customers, but the salesman who finds ways to deal with these customers shall thrive.

 

[ASD2019]

what are you talking about? you realize this is a little more complex than a binary system of does/does not have access to adequate health care providers? are you seriously that naive? if so, I've got some oceanfront property in OK to sell you

You seem to be going on many tangents (probably due to lack of comprehension). No one said anything about access. I was making the argument that reimbursements tied to overall patient outcomes would favor large integrated practice groups. These are integrated groups so they would contain doctors from all/many specialties in order to serve their patients. Having this integrated team would be better for patients than having the patient go to a PCP who just refers them to many, unconnected specialist who don't have much of an incentive to collaborate.

I never said/implied anything about equal pay of various specialties. Do hospitals pay all of their doctors the same salary regardless of their specialty? Having this large integrated group wouldn't be any different. The GI doc would still get paid more than FM because they bring in a larger portion of the group's reimbursements.

 

[Baller MD]

You realize that all of this stuff is actually happening, right? Accountable care organizations, shared savings programs, performance benchmarking?

You are railing against it like it is science fiction, when it is already going on.

Show me one successful/big aco right now. As far as I can tell no one is really interested in doing it. I could be wrong though.

 

[PL198]

You seem to be going on many tangents (probably due to lack of comprehension). No one said anything about access. I was making the argument that reimbursements tied to overall patient outcomes would favor large integrated practice groups. These are integrated groups so they would contain doctors from all/many specialties in order to serve their patients. Having this integrated team would be better for patients than having the patient go to a PCP who just refers them to many, unconnected specialist who don't have much of an incentive to collaborate.

I never said/implied anything about equal pay of various specialties. Do hospitals pay all of their doctors the same salary regardless of their specialty? Having this large integrated group wouldn't be any different. The GI doc would still get paid more than FM because they bring in a larger portion of the group's reimbursements.

I don't understand. I'm not going to work harder to help a patient that I refer to someone in my network vs someone out of it. Why does what group the referring physician in matter? If I'm going to dump patients due to ACA grading, I'm going to do it, regardless of whoever I'm dumping on is in network or out. What you're saying makes 0 sense. No one gives a crap if the other doc is in their group or not. The only way they'd care is if it's a partner owned group and thus they'd lose money for keeping the uncompliant patient in network. Therefore, they'd just refer them out to another group. I don't even understandthe benefits of what you're arguing. How exactly does having all the physicians in 1 group change anything for the patient? It doesn't change their care, at all.

 

[PL198]

Show me one successful/big aco right now. As far as I can tell no one is really interested in doing it. I could be wrong though.

yet school tries to ram it down our throats as so superior. hm wonder why no one wants to do it then and the only places I see thinking about it are academic centers? I'm pretty sure if it was so superior for the patient in all aspects like academia likes to say, then the people who actually care about money (PP) would take it up.

 

[Baller MD]

Here's a list of the current ACOs

http://www.cms.gov/Medicare/Medicar...ram/Downloads/2014-ACO-Contacts-Directory.pdf

The majority aren't actually AMCs. In fact, the whole thing has AMCs shaking in their boots - they lack the flexibility to go out and buy up other hospital systems that private hospitals/groups have. There is a lot of doom and gloom coming from AMC CEOs/CMOs about their ability to compete in the coming years.

amc = anesthesia management company?