By: Donald Marron

Donald Marron — Wed, 24 Jun 2009 23:13:41 +0000

Hi Clifton — Thanks for commenting. The issue of measuring and reporting quality — as measured by outcomes — strikes me as particularly important. There are challenges of course — you don’t want to discourage doctors from treating particularly sick or risky patients — but presumably some method of risk adjustment can eventually control for that.

The link to your blog didn’t work for me, but the following seemed to work:

doctorstalking.blogspot.com

(I’m sure you’ve heard enough jokes about “doctor stalking …).

As I am sure you know, you have a multi-talented son-in-law .

–Donald

By: Clifton K. Meador, MD

Clifton K. Meador, MD — Wed, 24 Jun 2009 14:53:01 +0000

Hello, I found you though my son in law Jon Shayne here in Nashville.
I have watched the decline in quality and the increase in cost for 54 years. It is tragic to see a once decent profession decline into greed and sleeze. You are on target with what you say but the change can only really come from within medicine. I know I have a simplified version of what would make some corrections but here are some for you to consider:
1. Use the medicare data to close bad hospitals (give them a year notice) from Medicare reimbursements.
2. Do not reimburse surgeons or hospitals who have unacceptable mortality, complication or infection rates for specific procedures.(Medicare funsa.
3. Pour funds into rebuilding primary care ( similar to military med school payments , to avoid debts and need to specialize.
4. Offer salaries comparable to surgeons’ incomes to primary care physicians- this through Medicare for those who would choose to do this.
The demise of primary care and the accessibility of the public directly into specialty care is the root of much excessive use. At first contact, most problems are psychosocial and not yet medical or physical in origin. Specialists ignore this fact and proceed to procedures, generating huge amounts of false positives that generate more procedures. Much of this could be avoided with strong primary , well paid, care.
5. Mandate each hospital to post on a bill board all of the procedures done in the past year, the mortality rate, the infection rate and the complication rate. The public has no way of knowing a bad from a good hospital. It is the reason that competition has failed to drive up quality and drive down costs.

check out my blog at http://doctorstalking.com

Clifton Meador, MD

Comments on: Health is an R&D Problem

By: Donald Marron

By: Clifton K. Meador, MD