Topic: GUIDELINES DRIVEN MEDICINE - THE BIG PICTURE BEGINS TO EMERGE
sometimesdilly
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Member # 9982
posted
An article in the New York Times today gives a glimpse into what's coming next for all American healthcare consumers- looks like the ISDA Lyme guidelines are part of a much larger picture.
In brief, physicians who follow whatever relevant set(s) of guidelines will receive bonuses (a carrot). Those who don't won't. Next step- the stick for those who don't follow the guidelines.
And meanwhile, the gvmt will be keeping track of which DR's follow guidelines and those who don't.
excerpt from the NYT --
Doctors had been fearing a pay cut under Medicare, the health care program for 43 million elderly and disabled, but Congress instead has offered doctors a small bonus with big strings attached. To get the money, doctors will have to report how often they provide quality care, as defined by the government.
Lawmakers approved the change as one of their final acts before adjourning early Saturday morning, and proponents said it would improve the quality of medical care.
But the plan immediately raised concerns among some doctors and lawmakers who specialize in health issues. They said they worried that it could be a step toward cookbook medicine and could erode the professional autonomy of doctors.
Doctors had been facing a 5 percent cut in Medicare payments in 2007. Congress deferred the cut, freezing doctors' payment rates instead.
Now, doctors can qualify for a 1.5 percent bonus in the second half of 2007 if they report data on the quality of their care, using measures specified by the government. For example, doctors could be asked to report how often they prescribe a particular drug after a heart attack or how well they control blood pressure in patients with diabetes.
With these statistics, Medicare officials say, they will , in the near future, be able to reward doctors who follow clinical guidelines and perhaps penalize those who flout such standards without justification.
(end of excerpt)
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The good news is that this larger picture should make larger coalitions possible. Folks, I do believe we are not in this alone. We're just being used as an experiment because many of us are so sick and not always able to fight back, and because the public as a whole does not know enough about Lyme.
Fighting the ISDA guidelines is so importamt- not just for ourselves and for the Lyme community, but for all of those who are going to be screwed next if we let 'em get away with this.
Dilly
Posts: 2507 | From lost in the maze | Registered: Aug 2006
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To answer my own question, the article does only talk about this in regards to medicare... not that that's ultimately reassuring.
Posts: 106 | From Michigan | Registered: Oct 2006
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Aniek
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I just want to throw some other thoughts out here. Don't kill me for this.
I'm not saying this is a good law. I don't know the full details of this law. But, there are some parts of medicine, where following guidelines will actually make it better for patients.
I'm doing research right now in racial disparities in the treatment of pain. Pain advocates actually support guidelines for pain treatment, because it would likely result in better/more pain treatment provided.
In general, guidelines surrounding treatment of heart disease, diabetes, etc. result in better care provided for racial minorities. Because in these cases where the condition is better understood and there is a larger consensus around treatment, guidelines set a minimum standard of care.
Obviously, I disagree with the IDSA guidelines for Lyme. I believe doctors need to have freedom to adapt treatment to individual patients.
But when you look at the data of doctors clearly prescribing less medication to patients of color, reporting with same symptoms, then I do support something that helps that. I'm not sure if this law actually does help. But there is more to medicine to Lyme.
-------------------- "When there is pain, there are no words." - Toni Morrison Posts: 4711 | From Washington, DC | Registered: Mar 2004
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charlie
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Does race, or worse, political correctness, have to be dragged into everything no matter whether it was part of the original question or not???
not bashing...just a question
Charlie
Posts: 2804 | From Texas | Registered: Oct 2000
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Cobweb
Unregistered
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I'm wondering how this would effect someone-like MOI-who is about to apply for SSDI. The Long Term Disability Insurance Company says a benefit to SSDI is being eligible for Medicare. Is Medicare a benefit or hindrance in the treatment of Lyme Disease ?
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Aniek
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quote:Originally posted by charlie: Does race, or worse, political correctness, have to be dragged into everything no matter whether it was part of the original question or not???
not bashing...just a question
Charlie
Charlie,
I just mentioned the race issue because I am writing a paper on it, so I happen to know that it is a place in medicine where guidelines can help. I was using it is an example to say that our experience with Lyme is not necessarily the experience of guidelines in medicine in general.
You will also notice I was talking unrelated to the Lyme guidelines. I don't think the IDSA guidelines would help anybody. But I wanted to show another angle to guideline in general in medicine.
And remember, we would love it if the ILADS guidelines were adopted by the government.
Carol - I doubt that this legislation will impact Lyme treatment under Medicare. There might be other people with Medicare experience and Lyme. But this legislation is probably targeted at the most common illnesses like heart disease and diabetes.
-------------------- "When there is pain, there are no words." - Toni Morrison Posts: 4711 | From Washington, DC | Registered: Mar 2004
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quote:Originally posted by Cobweb: Is Medicare a benefit or hindrance in the treatment of Lyme Disease ?
Well, there aren't many LLMD's who take Medicare....so that could be one problem.
-------------------- --Lymetutu-- Opinions, not medical advice! Posts: 96239 | From Texas | Registered: Feb 2001
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caat
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Member # 2321
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well... doctors taking medicare aren't getting very much to begin with. So, 1.5% isn't much of a carrot. Less doctors are taking medicare now it seems.
But what's troubling is;
"With these statistics, Medicare officials say, they will , in the near future, be able to reward doctors who follow clinical guidelines and perhaps penalize those who flout such standards without justification."
that's very troubling because those standards are generally about saving money when it comes to chronic illnesses.
Even if you don't have medicare or medical- many insurance companies look at medicare guidelines when they write their own up. If medicare can do it so can they. Especially if legislature has given an OK on it.
Posts: 1436 | From Humboldt county ca usa | Registered: Mar 2002
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sometimesdilly
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I agree, Aniek, that guidelines probably are useful at least some of the time for some people, and maybe even for a lot of people. I don't think guidelines per se are the problem.
In an ideal world, the very best academic researchers would join forces with the best treating DR's for every serious disease/illness, and together they would write guidelines that had as the only goal providing treating Dr' & their patients the most up to date best possible treatment information.
But that is obviously not how guidelines are drawn up now. The guideline writing process, and not just for Lyme, is less and less about best medical practices and more and more about profit margins and the exercise of various kinds of power.
So, if the process of formulating guidelines is corrupt, the resulting guidelines are as well- that was the purpose of the corruption after all,right?
So any system that then coerces DR's in to toe the line in following guidelines seems to me to be really really problematic at best.
Remmeber that the ISDA's chief rebuttal to criticism about the TBD guidelines is that the guidelines are "voluntary?" Which as we all know is utter bull manure for more than one reason.
I think one point to take away from this defense is that they know that plenty of people aren't ready to have their DR's discretion in how to treat stripped from them. So they mouth words in public that contradict what is right smack there page one.
To those who replied that the law just passed only relates to Medicare--
I've been around long enough to see how this kind of medical rationing- and that's what is going on here- gets rolled out.
Makes me feel antique, but when I first began choosing my own DR's as a young adult, I could go to anyone anywhere for anything and I didn't have to talk to anyone about it ahead of time.
I well remember how many of us were APPALLED at the rise of HMO's -- we figured there was no way people would put up with all the restrictions and the lesser care. We we wrong. People can get used to anything, especially when they feel powerless to change things.
I really think that what is coming our way in terms of medical "reform" etc., of which mandatory voluntary guidelines (accurate term: rationing) is only one part, will be FAR worse and more limiting than the HMO model.
Not a cause for despair- but one more reason to be really serious about fighting the ISDA guidelines....
dilly
Posts: 2507 | From lost in the maze | Registered: Aug 2006
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This isn't just the way medicaid rewards or punishes docs...insurance companies do the same type of incentives/punishments when their docs don't follow the plan's guidelines or drug formularies
Docs have become marginalized by this system...they no longer have free will to use their own judgement. That is why they are all going into fee for service type treamtnt (lasor hair removal, cosmetic procedures...etc)
This is bad for our country...
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