When will the Medical Bureaucracy learn that Performance Metrics in Healthcare can be Lethal?

Yet another scandal regarding performance incentives in healthcare has surfaced.  This time, the area is transplant medicine.  It was reported that the demands by the Center for Medicare and Medicaid (CMS) for extremely low complication and death rates (with the threat of loss of accreditation and shutting down of the program) has led to thousands of kidneys and livers being discarded while tens of thousands languish in waiting lists, desperate to escape the living hell that is dialysis.

Physician-Assisted-Suicide and Pay-for-Performance: an Unholy Union

Recently, a young woman named Brittney Maynard became a symbol for the Physician-Assisted Suicide (PAS) movement in the United States.  Brittney had been diagnosed with an incurable form of brain cancer- glioblastoma- which had recurred after an initial brain surgery.  She then moved to Oregon, one of three states where Physician-Assisted Suicide is legal by statute, and purchased the drugs which she could use to end her life.  She kept them with her until November 1st, 2014, when she took her own life.  But not before recording testimony to be played posthumously in California legislature where a bill was introduced which would legalize the practice of PAS.  The bill looks increasingly likely to pass, as the California Medical Association which killed previous versions of the bill now looks to stay neutral and sit out the fight due to changing attitudes among its member physicians.

I have serious concerns about the way PAS comes to be implemented, and how it will interact with the statistical measures that are increasingly being adapted throughout the healthcare system to "measure quality".

Why Your Doctor Doesn’t Work For You

Many doctors are ambivalent about the Affordable Care Act. This is not due to the primary aims of the bill- after all, more people with health insurance means more paying patients, so what’s not to like? Rather, doctors are worried about the other, less publicized pieces of the bill, and related changes to Medicare and Medicaid that have quietly reshaped medicine- and often not for the better.

Primary Care vs. Specialist Pay, the RUC, and the News.

The Relative Value Scale Update Committee (RUC) of the American Medical Association (AMA) is back in the news, courtesy of the New York Times.  It's more of the usual story, published by the WSJ less than 4 years ago: specialists are paid too much, primary care physicians are paid too little, and it's all because of an evil committee of doctors who are members of the evil medical trade union group known as the AMA who set payments.  (Full disclosure, I'm a proud member of the AMA).  A good perspective on the debate from Paul Levy, a former non-physician hospital CEO, is here.