tag:blogger.com,1999:blog-11034229.post115676977743515891..comments2023-07-14T02:53:40.719-07:00Comments on retired doc's thoughts: Houston V.A. physicians examine P4P data and find evidence of gaming and treating the chartjames gaultehttp://www.blogger.com/profile/05537303135780186926noreply@blogger.comBlogger3125tag:blogger.com,1999:blog-11034229.post-1157039555240734882006-08-31T08:52:00.001-07:002006-08-31T08:52:00.001-07:00gaming and treating the chart: no big surprise. P4...gaming and treating the chart: no big surprise. P4P is a worthy concept at some level. Implementation of meaningful parameters seems literally impossible. Of necessity, it must involve relatively simple, black-and-white data points that say little about overcall care provided by a given doc.Sid Schwabhttps://www.blogger.com/profile/14182853083503404098noreply@blogger.comtag:blogger.com,1999:blog-11034229.post-1156870708897249362006-08-29T09:58:00.000-07:002006-08-29T09:58:00.000-07:00Intuitively, one would think that clinical effecti...<I>Intuitively, one would think that clinical effectiveness would, over the long term, tend to decrease costs on average. <BR/></I><BR/>Not necessarily. Say someone gets treated and lives a long life but takes a lot of drugs. Someone else doesn't get treated and dies. Clinically effective, but hardly saves money.<BR/>Or consider something like mammograms. You need to screen a thousand for 10 years to save one life; you can assume you may save on treatment of this one person and a couple of others (in some cases early diagnosis will not translate into savings). During the same 10 years over 50% of these 1000 women will have a recall because of false positive (cumultive, 10% after 1st mammogram, slightly less for subsequent one),around 10% will have biopsies (or something like it, could be 7% or 18, I don't remember). Moreover, because of overdiagnosis you will have more women diagnosed with breast cancer, so you end up treating more women at least with surgery and radiation. So the costs of screening and treating extra women will be way over savings. So clinically you get some lives saved, but at a cost.<BR/><BR/>Not sure about other preventive things like statins. What if someone still ends up having a heart attack but later? What about all of the extra people who would've never had a heart attack even with treatment.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-11034229.post-1156795268825290822006-08-28T13:01:00.000-07:002006-08-28T13:01:00.000-07:00Is the goal simply to be cost-effective, or is the...Is the goal simply to be cost-effective, or is the goal to also be clinically effective? Is there any relationship between cost-effectiveness and clinical effectiveness?<BR/><BR/>Intuitively, one would think that clinical effectiveness would, over the long term, tend to decrease costs on average. <BR/><BR/>I think the trouble is, this is very hard to measure, especially if you are looking at clinical practices that might not pay off in ways that are immediate and/or obvious.Anonymousnoreply@blogger.com