Health Policy Updates....

Specialties NP

Published

one of the big pushes by this administration, and by congress, as pertains to health reform is centered around "paying for performance".....

i am intimately involved with the mayo clinic health policy center, and this is one of their cornerstones as well.

i'd like to hear from other people here as to their definition, and interpretation of what this means, and how it might impact your practice(s).

here's some more info to digest as well:

[color=#036c9b]http://healthpolicyandmarket.blogspot.com/

thoughts?

some people are concerned that this could lead to a rationing of care.

rationing already occurs to a large part. right now, we ration care by insurance status. patients without insurance, or without good insurance, cannot obtain appointments, and cannot get adequate care.

rationing is inevitable. look at it this way. there are two factors here.

1. there is a finite amount of money available to pay for care. despite you having insurance, there is still only so much money in the pool.

2. there is a limit to the amount of resources, or care available.

now, in order to provide unlimited care to everyone, you need to have an unlimited pool of money, which we do not have. therefore, one pool, or the other needs to be managed, or rationed effectively.

it is simply reality. my question, is how should we ration care?

my opinion is to really ration care in the last six months of life, and amongst the elderly. greater utilization of hospice for end stage patients. decreased use of multiple medications and procedures that cost a lot, but have little if any proven benefit.

for example, in the uk, i understand that if you are 80 years old, and develop renal failure. you don't get dialysis. not usually. they have decided that at the age of 80, the amount of return that their society will get, measured against the massive costs, are not worth the investment. how would that go over here?

these are kinds of difficult discussions that our "american idol" culture is going to have to face, and answer.

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