The Stimulus Bill and Vaccines - Page 5

[eireann]

i read the bloomberg article. ugh. nothing like the shadow of big brother to make your health care needs, quality of them, and civil rights diminish. sheesh.

[mamakay]

Originally Posted by ccohenou

My general impression is that the point of pay for performance is to increase the delivery of evidence-based care. Decreasing the delivery of non-evidence-based care (all those spinal fusions for back pain or carotid artery reamings for instance) would be a welcome step too. And then decent EMRs could also provide a really useful new source of evidence so that care can have more of an evidence basis in the future (of course medical records are already used in research, in an IRB-approved privacy-protecting way). And really, the opt out is there just like it's there for all Medicare/Medicaid policies: don't accept Medicare payments.

Anything has some potential for misuse....paper medical records have their own documented problems and association with deadly medical errors too, right?

The opt-out is not there for either providers or patients. Well, I guess the opt out for both might be only using/becoming "retainer" practices, but this is not possible for the masses.

Regarding this:

My general impression is that the point of pay for performance is to increase the delivery of evidence-based care.

Who's evaluating the evidence? What evidence are they evaluating?
Is (for example) mass varicella vaccination a good idea on a population level in terms of population outcomes and cost effectiveness?
How well do the guidelines actually work?

What kind of improvment do EHRs bring?

http://circ.ahajournals.org/cgi/cont...bstracts/S_714

Electronic health records (EHR) are purported to be an important technology to improve the quality of health care, yet few data exist regarding the effect of EHR on the delivery of evidence-based care in the outpatient setting.

IMPROVE HF is a prospective cohort study of 15,381 patients with diagnosed HF or prior myocardial infarction and EF 35% receiving care at 167 US outpatient cardiology practices

Findings suggest that current use of EHR results in little improvement in the quality of HF care compared with paper-based systems. Additional research is required.