tag:blogger.com,1999:blog-4968787219619380438.post2756581524091966038..comments2023-09-21T04:02:29.457-04:00Comments on Skeptical Scalpel: Central Line Bloodstream Infections & Pay for PerformanceSkeptical Scalpelhttp://www.blogger.com/profile/13206922456661320751noreply@blogger.comBlogger7125tag:blogger.com,1999:blog-4968787219619380438.post-32208520508985199522012-06-02T17:23:37.001-04:002012-06-02T17:23:37.001-04:00Marya, Thanks so much for commenting. I agree with...Marya, Thanks so much for commenting. I agree with you that a lot of what is being done is for "show" and not really useful.<br /><br />Marya blogs at http://evimedgroup.blogspot.com/ and has written a book called "Between the Lines: Finding the Truth in Medical Literature."Skeptical Scalpelhttps://www.blogger.com/profile/13206922456661320751noreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-53570399334722623062012-06-02T12:03:02.820-04:002012-06-02T12:03:02.820-04:00I totally agree with Chris above -- too much rando...I totally agree with Chris above -- too much randomness and variability in the outcome, especially if looking at single institutions and even more among single providers. Outcomes need to be measures in large multi-center studies to see how the processes are doing at achieving these desired outcomes. I have written ad nauseam about using these so-called QI measures as a P4P yardstick This particularly salient for VAP, where we don't even know what VAP is. My impression is that we are spinning our wheels just to make it look like we are trying to remedy the catastrophic loss of life in conjunction with the exposure to healthcare. In reality, an this is supported by Landrigan's paper in the NEJM, we have accomplished very little. The problem? Quality science lacks scientific quality. <br /><br />Sorry for the rant.<br />MaryaMarya Zilberberghttps://www.blogger.com/profile/16080475886113209344noreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-51956514053871430992012-06-02T01:02:52.418-04:002012-06-02T01:02:52.418-04:00Chris, not a bad idea. It makes sense. That's...Chris, not a bad idea. It makes sense. That's why it will never happen.Skeptical Scalpelhttps://www.blogger.com/profile/13206922456661320751noreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-9999624846276681312012-06-01T23:42:41.131-04:002012-06-01T23:42:41.131-04:00I'm for pay-for-performance which is process b...I'm for pay-for-performance which is process based, but not outcome based. That is, if you put in a central line using the techniques we believe reduce infection risk - get paid. If pay is linked outcome, then you won't necessarily be rewarded for doing everything right when your patient gets an infection anyway.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-3734739871421547002012-06-01T21:23:26.754-04:002012-06-01T21:23:26.754-04:00Tonja, Interesting story. I hope you get it sorted...Tonja, Interesting story. I hope you get it sorted out. It could impact your health or life insurance.<br /><br />Anon, I don't think the rules have gone into effect yet.Skeptical Scalpelhttps://www.blogger.com/profile/13206922456661320751noreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-62121410575394562952012-06-01T17:36:09.678-04:002012-06-01T17:36:09.678-04:00Are we really talking pay for performance? Who out...Are we really talking pay for performance? Who out there with a 0% central line infection rate has seen an increase in Medicare payments or a bonus for doing so well and helping the system save billions of dollars by reducing complications?Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-87036903226738296862012-06-01T10:30:39.093-04:002012-06-01T10:30:39.093-04:00Agreed. Another problem with ICD-9 codes is that ...Agreed. Another problem with ICD-9 codes is that once a patient is coded, they can't be removed without going through a whole mess of appeals, and usually that doesn't even do it! I had a doctor diagnose me as diabetic, and I'm not, but there it is in all my records forever and ever...Anonymoushttps://www.blogger.com/profile/00529039585376129478noreply@blogger.com