Evidence Based Medicine Fact vs Myth Richard O

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Evidence Based Medicine Fact vs. Myth Richard O. Dolinar M. D. © 2005 Bilao

Evidence Based Medicine Fact vs. Myth Richard O. Dolinar M. D. © 2005 Bilao LLC

Quality Based Purchasing I. Evidence Based Medicine – the foundation II. Best practices –

Quality Based Purchasing I. Evidence Based Medicine – the foundation II. Best practices – the standard III. EMR – the monitor IV. Outcomes Measurements – the gauge V. Pay for Performance – the enforcer © 2005 Bilao LLC

I. Evidence Based Medicine the foundation – A. Definition of evidence B. External validity

I. Evidence Based Medicine the foundation – A. Definition of evidence B. External validity C. Evidence based? © 2005 Bilao LLC

“Evidence based medicine is managed care masquerading as science. ” Twila Brase R. N.

“Evidence based medicine is managed care masquerading as science. ” Twila Brase R. N. President of the Citizens Counsel on Healthcare 2005 © 2005 Bilao LLC

II. Best Practices – the standard A. Group vs. individual best B. Algorithms replace

II. Best Practices – the standard A. Group vs. individual best B. Algorithms replace medical judgment C. Mistakes institutionalized D. The problem of knowledge © 2005 Bilao LLC

D. © 2005 The problem of knowledge: Clinicians practicing medicine apply prudent decisions in

D. © 2005 The problem of knowledge: Clinicians practicing medicine apply prudent decisions in reaction to ever changing circumstances that only they can know. Bilao LLC

In Reality: The “Best Practice” is to treat patients according to their individual needs

In Reality: The “Best Practice” is to treat patients according to their individual needs © 2005 Bilao LLC

III. Electronic Medical Records the monitor – A. Cost effective vs. cost prohibitive B.

III. Electronic Medical Records the monitor – A. Cost effective vs. cost prohibitive B. An accurate portrayal of patient care? C. Benefits whom? © 2005 Bilao LLC

IV. © 2005 Outcomes Measurements – the gauge A. Measurements could appear to be

IV. © 2005 Outcomes Measurements – the gauge A. Measurements could appear to be improving but in reality things could be getting worse B. Physicians vs. patient outcomes Bilao LLC

V. © 2005 Pay for Performance - the enforcer A. Pay for compliance B.

V. © 2005 Pay for Performance - the enforcer A. Pay for compliance B. Responsibility without power C. Fruits/vegetables D. Physician misclassification E. SGR/No new money Bilao LLC

Pay for performance “Analyzing patient data, measuring physician performance, and calling the process “scientific”

Pay for performance “Analyzing patient data, measuring physician performance, and calling the process “scientific” is the mechanism being used today to shift power and control away from physicians. ” Gary Belkin 2004 © 2005 Bilao LLC

rd 3 Doctor © 2005 Party Patient Bilao LLC

rd 3 Doctor © 2005 Party Patient Bilao LLC

A buys from B C pays Modified from reference: Kleinert, Richard. Deloitte Consulting LLP

A buys from B C pays Modified from reference: Kleinert, Richard. Deloitte Consulting LLP Human Capital Practice. WARD’s Auto World, February 2005. 1965 House of Representatives Minority Report regarding the financing of Medicare © 2005 Bilao LLC

Health Savings Accounts © 2005 Bilao LLC

Health Savings Accounts © 2005 Bilao LLC

Questions? ? ? © 2005 Bilao LLC

Questions? ? ? © 2005 Bilao LLC

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