Re: Evidence-based Care

December 17, 2008

Your friend is full of you know whatEVEN IF all those awful poorly trained PCPs out there were really doing all those unnecessary cbc's lets' see at 11.00 each how long would it take to have the cbc's cost add up to buy a pill of gleevac or the oncology pill du jour?

Your frined has lousy info and likes to shift blameI see lots of charts as people come in as new patietns i have a doc. My husbdan goes to a doc. I have been a doc. for long time. working at a VA for three years ALWAYS reading other peoples chartthere VERY feW unnecessary tests

In fact sometime folks were started on statins and never had followup lfts orl ipidsYour frined is not helpful in the mess that is health care.Send him over and i will tell him so.Jean. firmly.

As we spend a good bit of energy (myself certainly included) highlighting the way insurance

companies mistreat primary care, I thought it only fair to relay this story in the interest of

balance...

I was talking with a friend of mine who works for a large insurance company. He told me

that they could pay for every experimental protocol for end-stage cancer request they

receive each year in the U.S. if they could only get primary care docs in Wichita (or any other

city of similar size) to stop ordering non-indicated screening labs (lfts, cbcs, basic lytes, etc)

and CXRs on asymptomatic patients. He said specifically " we love primary care when it's

done right because it saves us a ton of money - the problem is our experience is that most

primary care docs don't practice EBM - and for us that's a real hurdle to the logic of

increasing what we pay them. "

Food for thought...

Chad

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December 17, 2008

Chad, Rian's viewpoint is that he will derive his knowledge of evidence-based care from reading his medical journals and from attending academic sponsored CME seminars. For insurance companies to waste precious dollars with whole departments devoted to creating practice guidelines for physicians and whole departments that create the tri-color brochures and mailings to physicians with these guidelines is a giant waste of precious health care dollars. Rian said he doesn't know a single physician, if given the choice, who would pick up the guidelines written by BCBS to read if he can pick up his latest family practicejournal to read guidelines, instead. He finds it insulting that insurance companies feel the need to tell physicians how to manage diabetes, for example. As if physicians aren't already seeking the best advice they can get! If they are not,they surely need to seek it directly from the profession and not from insurancecompanies. Imagine the dollars that could be saved in healthcare if all theinsurance companies stopped this wasteful advising practice. When we get that kindof "junk mail", it immediately goes in the trash. The elephant in the middle of the healthcare room (between the provider on one end and the patient on the other) not only siphons off 1/3 of the dollar that goes from one end of the room to the other, the elephant tells the doctor/hospital/homecare agency how to do their work. It's absurd.a Moffice managerAs we spend a good bit of energy (myself certainly included) highlighting the way insurance companies mistreat primary care, I thought it only fair to relay this story in the interest of balance...I was talking with a friend of mine who works for a large insurance company. He told me that they could pay for every experimental protocol for end-stage cancer request they receive each year in the U.S. if they could only get primary care docs in Wichita (or any other city of similar size) to stop ordering non-indicated screening labs (lfts, cbcs, basic lytes, etc) and CXRs on asymptomatic patients. He said specifically "we love primary care when it's done right because it saves us a ton of money - the problem is our experience is that most primary care docs don't practice EBM - and for us that's a real hurdle to the logic ofincreasing what we pay them." Food for thought...Chad

December 17, 2008

OK. I'm sorry for not knowing the exact numbers. I hope, perhaps, someone from the

academic areas has the info. But, what percentage of all health care costs are

paid out for primary care medicine (pay to docs and charges for what they

order)? Then, I wonder, what percentage of insurance premium payments go to

insurance company overhead?I am willing to bet that cutting down on

insurance company overhead by 1/5-1/3 would be a much, much better savings than

cutting down on " inappropriate " medical services (tests ordered, etc) by

primary care.If the insurance companies wanted to save money, they'd

help primary care thrive so the docs aren't harried and can actually focus on

medical care. That, I believe, would cut down on referrals to specialists who

charge more per appt and really do order many more tests (very often very

appropriately... this is not a rant against specialists who I admire and appreciate

a lot). Primary care that is properly comprehensive and then makes the most

reasonable and well-timed referrals is the most cost-effective method. A

payment system that supports docs to do that is the best answer for American health

care.Ask your friend those questions and see what he says?TimOn Wed, December 17, 2008

11:05 am EST, a Mintek wrote:

Chad,

Rian's viewpoint is that he will derive his knowledge of evidence-based care

from reading his medical journals and from attending academic sponsored

CME seminars. For insurance companies to waste precious dollars with whole

departments devoted to creating practice guidelines for physicians and whole

departments that create the tri-color brochures and mailings to physicians with

these guidelines is a giant waste of precious health care dollars. Rian said he

doesn't know a single physician, if given the choice, who would pick up the

guidelines written by BCBS to read if he can pick up his latest family

practice

journal to read guidelines, instead. He finds it insulting that insurance

companies feel the need to tell physicians how to manage diabetes, for example.

As if physicians ar en't already seeking the best advice they can get! If

they are not,

they surely need to seek it directly from the profession and not from

insurance

companies. Imagine the dollars that could be saved in healthcare if all the

insurance companies stopped this wasteful advising practice. When we get that

kind

of " junk mail " , it immediately goes in the trash.

The elephant in the middle of the healthcare room (between the provider on one

end

and the patient on the other) not only siphons off 1/3 of the dollar that goes

from

one end of the room to the other, the elephant tells the

doctor/hospital/homecare

agency how to do their work. It's absurd.

a M

office manager

As we spend a good bit of

energy (myself certainly included) highlighting the way insurance companies

mistreat primary care, I thought it only fair to relay this story in the interest

of balance...I

was talking with a friend of mine who works for a large insurance company. He told

me that they could pay for every experimental protocol for end-stage cancer request

they receive each year in the U.S. if they could only get primary care docs in

Wichita (or any other city of similar size) to stop ordering non-indicated

screening labs (lfts, cbcs, basic lytes, etc)

and CXRs on asymptomatic patients. He said

specifically " we love primary care when it's done right

because it saves us a ton of money - the problem is our experience is that most primary

care docs don't practice EBM - and for us that's a real hurdle to the logic ofincreasing what we pay them. " Food for thought...Chad

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December 17, 2008