Hits & Misses – 2009/7/6
The average time spent for each visit to an emergency room is 4 hours and 3 minutes.
A glowing description of "patient-centered medical homes," but they still don't understand "marginal product."
Knee replacements are cost-effective. But the people who get the benefits are the people who bear the cost.
On emergency room waits, You are right John. We are becoming just like Canada.
As previously mentioned at this blog, the use of the emergency room did not change in Massachusetts,even after they “insured” half the uninsured.
What do you mean by marginal product?
A good primary physician– at least one who happens to be on the roster at your local hospital– can go a long way toward expediting any visits to the E.R.
Marginal product is the value of the physician’s time devoted to different tasks. Ideally, you would like the physician to allocate his time so that he maximizes the value of care to the patients. In a market, that tends to happen naturally. In bureaucratic systems, it rarely happens at all.
The comments section of the NYT article was closed, so I will vent here. Despite the assertion to the contrary, the managed care gatekeeper function 25 years ago was EXACTLY like the medical home being touted. I know, because I started my family practice career in 1982 and we used the same phrases: coordinate care, quarterback,focus on preventive care, keep people out of the ER and hospital. The payment mechanism was capitation. There has been little change in the playbook. OK, now the primary doc gets a fee for coordinating care, with bonuses for keeping people out of the hospital (saving money). Nobody is talking about cherry picking, adverse selection and trying to do the work of a specialist for a generalist’s fee. That is what is about to happen. I hate to rain on anybody’s parade, but we are about to re-live something that already happened. And the results weren’t pretty.
First of all it is only fair that I iitnedfy my self as a VA employee. I read many of the comments here with interest and great concern. Most of the comments that I read seem to relate to unacceptable individual experiences that really should not rise to the level of tarnishing the individual VA hospital. Inappropriate individual staff can create an adverse impression of the quality of care and services at any VA. While the same level of care should be available at any VA you go to, it is realistic to understand that we are dealing with a human element that if not trained appropriately can project the wrong impression about a very good system of healthcare. Sometimes the perceptions and expections are all wrong before a veteran have any contact with the VA because they were educated elsewhere of what they should expect or is entitled to. As a veteran, all my healthcare is received through the VA. I have commercial health insurance and can go anywhere I choose but I choose the VA because of my experices with private care providers. Yes have encountered inappropriate interaction with some staff but I deal with those individual situations without any negative comments about the facility. The way to correct many of the adverse situation you encounter is to follow the complaint system and also get your CVSO involve. Personally I find the VA,not because I am an employee, to be a very excellent healthcare provider. Provide some positive feed back because the negative feed back can do more to hurt than help those uninformed veterans that are seeking care and care they deserve.
The issue mentioned with uiecetxng content remotely when it was sourced from another application is not a difficult problem to fix. I’ve seen this a number of times when rendering CDATA content with XSL; no matter how the content is enclosed/sanitized, CDATA and notably disable-output-escaping needs output sanitizing as well.I’d be interested in your brewing article, In Defense of Walled-Gardens. I am not for these large centralized services with user lock-in, and federation is an appealing concept, be it an old concept when we look at email. The benefit is openness and detachedness.I can’t say how many times I’ve wanted to post a reply to a number forums topics, but am unable without registering and logging in. The issue is, I don’t want multiple accounts on services with redundant functionality. Social networks are a great example because they generally all provide the same features, but each requires usership to interact, they are all closed communities.If you do write the article, I hope to see some analysis of the OpenMicroblogging specification, which imo is a decent open solution, and I think it keys on the main factor federated social system must rely on for security and that is the social relation opt-in. A user subscribing to another [possibly federated] user’s content is making that decision, essentially yielding authorization for a publisher to post to the subscriber’s inbox. If the publisher decides to exploit this fact, or is compromised, what is the exact security threat? I believe it varies between systems, especially when comparing OMB and Wave.OMB is generally rendered in one specific way, while Wave will allow self-defined rendering with widgets/html/js/css. In that light, I don’t necessarily feel the architecture is a threat, but I do think the content possibilities need a sanitizing method at a more fundamental level in the overall system.Federation is a long-standing, open solution, email proves that. When the concept of walled gardens expires and the focus shifts to federated solutions, I think we will have the right answers.This is why I enjoy the best open+social community, the blogosphere.