Thursday, February 10, 2011

Thursday thoughts

The Kaiser Health News reports about a newly published book by a true contrarian -- "Overdiagnosed: Making People Sick in the Pursuit of Health," authored by Dartmouth researchers and physicians H. Gilbert Welch, Lisa Schwartz and Steven Woloshin.  Check out this excerpt from the Q&A with Dr. Welch:
Q. Many health care experts today say it's important that everyone have a "medical home": a primary care physician who's their regular go-to person for routine and preventive care, and who coordinates their care with specialists and other health care providers when necessary. If you're healthy, do you need a medical home?A. The patients that most need a medical home are those with multiple chronic conditions and who are on many medications.
For people who are well, the virtue of having a regular primary care physician is to establish a relationship and to establish the set of values that will guide your care. You can talk about where you are on the spectrum between aggressively looking for early signs of disease and waiting until you have symptoms to seek out treatment. The first may have the potential benefit of early diagnosis, but the potential harm of being diagnosed and treated for problems that will never become relevant.
Q. What's on your wellness wish list?A. Let's help people learn how to ask good questions of their doctors. How to understand risk and health statistics so they can make better decisions. Wellness programs could educate and inform people about how to be a critical consumer of health care. Wouldn't that be something?

Speaking of medical homes, the AMA News reports on the NCQA's recently revised accreditation standards for medical home providers. According to the report, the revised standards "place greater emphasis on patient feedback, access to physicians and care coordination."  Here's a physician's perspective from the article:

Peter McDougall, MD, a solo family physician in Fort Worth, Texas, has been recognized as a level 3 NCQA medical home since March 2010. He was in a good position to receive recognition because he's had an EMR system since 1997. Staff members enter data during patient visits and follow up with patients.
Dr. McDougall spent about $8,000 and several months in 2010 to receive the certification. He said his patients gave him a lot of positive feedback about the achievement. Most NCQA standards make a lot of sense, he said.
Dr. McDougall said doctors should look at NCQA recognition as a reward in itself, not a fast track to better payment. "If your goal is to increase payment by recognition, I think that's way in the future and very cloudy," he said. "I know the payers quite well. They really don't have a good feel at all for what this process is."
As FEHB plans are created by federal government contracts, it's worth noting a report that "The Obama administration announced today [in the Federal Register] it was withdrawing a proposal that would have required federal agencies to post copies of contracts and task-and-delivery orders on a public website."

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