tag:blogger.com,1999:blog-26666124.post8674778373141695321..comments2024-03-18T03:28:36.581-04:00Comments on Shrink Rap: Rate-A-DocUnknownnoreply@blogger.comBlogger11125tag:blogger.com,1999:blog-26666124.post-58322558683420347662007-03-26T17:16:00.000-04:002007-03-26T17:16:00.000-04:00Clink,I'm with Carrie on the sounding like the "ti...Clink,<BR/><BR/>I'm with Carrie on the sounding like the "tick-boxes in the NHS."<BR/><BR/>I know that I don't want a bit of my very expensive Shrink appointment to be wasted with stupid questions or irrelevant questions.<BR/><BR/>I don't understand how any reasonable person can think that it is possible to rate the performace of a professional on an outcome they are not 100% in control of.<BR/><BR/>I see a Shrink and he has prescribed for me three meds. If I don't get better because I didn't take them, how is he responsible for that? Even if I DO take them and don't get better (what does "better" mean when you are talking about a psych PT anyway?)that's not necessarily Shrink's fault, no matter how much I want to blame him.<BR/><BR/>I've been feeling so much better for about three weeks. What's different? I have no idea. Why should he get the credit?<BR/><BR/>Anyway, I can't believe the AMA, who has such a powerful lobby, isn't going to get this little initiative killed. This is just what we DON'T need, non-medically trained beaurocrats poking their heads in doctors' business.<BR/><BR/>LDrivingMissMollyhttps://www.blogger.com/profile/11476761316928942301noreply@blogger.comtag:blogger.com,1999:blog-26666124.post-30448890825318201742007-03-26T05:10:00.000-04:002007-03-26T05:10:00.000-04:00Actually, if you knew how much that $600 per child...Actually, if you knew how much that $600 per child per year would go . . . . . heck just $600 more per year per class, would let em buy some good stuff for one classroom, say my daughter's. Or let them actually go on field trips that you don't have to do a zillion bake sales or whatnot to raise the funds for.<BR/><BR/>Let's see, 30 kids per class (it's close to that, here, which is ridiculous) timex $600 - that's $18,000, isn't it? <BR/><BR/>The school has to beg and plead for monies to help them in many areas, but especially for more licenses for a math program on the computers, which I think might be recommended or mandated by the state, but certainly not funded (arg). They only have enough licenses so only 6-8 kids in the school can be using the program at once.<BR/><BR/>That's just STUPID. Each license is $1500 (ouch).<BR/><BR/>Anyway, it's alot of money, in a state where since there's more kids per household than other places, that makes the taxes higher to educate each child (we had a huge state surplus this year, I hope they sent alot of it to education but I don't think they did, idiots. Mental health too.) They are having to beg teachers to come out of retirement or put it off, cause they have trouble getting new teachers (gee, at the paltry rate they pay I wonder why?)<BR/><BR/>Anyway! The teachers and educators still supported leaving NCLB tho, because it was a PITA, with some stupid measures in it.<BR/><BR/>Sorry to go on so long! I'm pleased that you googled it though, and took an interest in it!Sarebearhttps://www.blogger.com/profile/09208596053319110470noreply@blogger.comtag:blogger.com,1999:blog-26666124.post-18992446689139649402007-03-25T19:48:00.000-04:002007-03-25T19:48:00.000-04:00I like that. Hmm...let's see...pay for performance...I like that. Hmm...let's see...pay for performance politicians?<BR/><BR/>Naw...we've already <A HREF="http://www.wtop.com/?nid=598&sid=1094458" REL="nofollow">got that here in MD</A>.ClinkShrinkhttps://www.blogger.com/profile/13316134491751195651noreply@blogger.comtag:blogger.com,1999:blog-26666124.post-37218583793248730362007-03-25T18:56:00.000-04:002007-03-25T18:56:00.000-04:00Maybe we should have pay 4 performance for custome...Maybe we should have pay 4 performance for customer service reps at insurance companies. If they provide crappy service (or deny/drag their feet processing claims), I send them less $$ each month? What do you think?Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-26666124.post-39483939934665972922007-03-25T17:56:00.000-04:002007-03-25T17:56:00.000-04:00That's not much of a loss Sarebear; I did a little...That's not much of a loss Sarebear; I did a little <A HREF="http://www.friedmanfoundation.org/utahfiscal.pdf" REL="nofollow">googling</A> and it looks like the Feds fund only about $600 of the $6300 per student per year that goes into public education there. Hardly enough of an incentive to comply with NCLB. I'm surprised more states don't opt out.<BR/><BR/>Thanks for the pic Dinah. I'm getting lazy---I took it for granted you'd find a good one.ClinkShrinkhttps://www.blogger.com/profile/13316134491751195651noreply@blogger.comtag:blogger.com,1999:blog-26666124.post-10327753505711305162007-03-25T01:26:00.000-04:002007-03-25T01:26:00.000-04:00Oy, that's just sad.My state has rebelled and opte...Oy, that's just sad.<BR/><BR/>My state has rebelled and opted out of the No Child Left Behind thing, which means less to little to no federal funding of a variety of kinds, but . . . it's too rigid. <BR/><BR/>Plus, with Utah's 50% Mormon population, there are rather more kids per household or whatever than many places . . . also the tiny farming towns and other such, and way spread out small towns . . . No Child Left Behind just doesn't fly well, here.<BR/><BR/>Not what the post is about, but yeah it goes to show how the one size fits all approach just sucks.Sarebearhttps://www.blogger.com/profile/09208596053319110470noreply@blogger.comtag:blogger.com,1999:blog-26666124.post-22737839465452978902007-03-24T17:14:00.000-04:002007-03-24T17:14:00.000-04:00Yes Catherine it is very similar to teaching I thi...Yes Catherine it is very similar to teaching I think; during this seminar I kept thinking of No Child Left Behind and some of the discussions I've had with a friend of mine who is a school reform advocate. Even if the *only* thing you are looking at is outcome, the number of confounding variables are enormous. And there is no guarantee that your benchmarks actually are associated with "quality" care or good outcome.<BR/><BR/>Nevertheless, this is where we are headed. The thing that I thought was fascinating was that even in free society, with insurance, the majority of patients aren't getting care associated with benchmark standards. The presenter showed data that even with insurance, 25% of inpatients are not getting a followup appointment within 30 days after discharge. For medicare and medicaid recipients it was even worse---something like 10% got seen within 30 days. And this included followup by a non-mental health professional (eg. primary care doc).<BR/><BR/>The other thing that struck me was that our correctional contract had standards that are higher than what some of the P4P folks are proposing. Interesting considering that we have higher volume, sicker patients and fewer resources than the clinicians they are targeting out there in free society.ClinkShrinkhttps://www.blogger.com/profile/13316134491751195651noreply@blogger.comtag:blogger.com,1999:blog-26666124.post-16331215747146161562007-03-24T16:52:00.000-04:002007-03-24T16:52:00.000-04:00Benchmarks are tough. You can't judge outcomes, b...Benchmarks are tough. You can't judge outcomes, because your outcomes are highly dependant on the risk of your population. Then, you have to look at the evidence for things associated with good care. Evidence is very tricky, and often doesn't exist for things that we "know" work. Various studies have various flaws and may or may not be applicable to the patient population you're taking care of; not only that, there's a great deal of variability within populations. Its reminiscent of when insurance companies were trying to make obstetricians try to make every woman with 1 previous c-section VBAC, whether or not they were really good candidates.Midwife with a Knifehttps://www.blogger.com/profile/04309579302399381913noreply@blogger.comtag:blogger.com,1999:blog-26666124.post-49013742868519982802007-03-24T16:43:00.001-04:002007-03-24T16:43:00.001-04:00Reminds me of what my state wants to do for teache...Reminds me of what my state wants to do for teachers (but hasn't yet, thank goodness). Like you mentioned in the post, there is inpatient vs outpatient vs partial hospital - all of which have specialized needs that are tailored to the services they provide. How is possible to have a gold standard for everyone when, like neonursechic said, "There are so many exceptions"? It's not possible. If everyone had the exact same type of patients, cookie-cutter patients, then it might be feasible. But they don't.Catherinehttps://www.blogger.com/profile/18012100875719616898noreply@blogger.comtag:blogger.com,1999:blog-26666124.post-19054758317024467242007-03-24T16:43:00.000-04:002007-03-24T16:43:00.000-04:00OT but I'm not sure if all of you can read my blog...OT but I'm not sure if all of you can read my blog, or just Dinah can. At any rate - let me know and I will try to fix it so that all of you can see it. I have recorded some <A HREF="http://homepage.mac.com/lizzpiano" REL="nofollow">new music</A> - really I re-recorded 3 songs: "I Can't Make You Love Me", "Memory" and "I Know The Truth" and then just recorded one new song, "There You'll Be". Just thought you might be interested! Let me know about the blog... Take care!<BR/><BR/>Carrie :)NeoNurseChichttps://www.blogger.com/profile/16120931307124798416noreply@blogger.comtag:blogger.com,1999:blog-26666124.post-78237154558377984722007-03-24T15:24:00.000-04:002007-03-24T15:24:00.000-04:00It sounds like the tick-boxes in the NHS, and that...It sounds like the tick-boxes in the NHS, and that's just scary. As not everyone fits into strict diagnostic criteria for a certain illness, not everyone will fit into a strict protocol for what is supposed to be done. There are so many exceptions - and the exceptions are what neeed the most care, the most help, the most medical attention - as they are the difficult cases - the ones that are hard to fix. But maybe that's just me...<BR/><BR/>Looking forward to seeing Roy's post, too!<BR/><BR/>Take care,<BR/>Carrie :)NeoNurseChichttps://www.blogger.com/profile/16120931307124798416noreply@blogger.com