tag:blogger.com,1999:blog-2308282620289958037.post5353798757676726852..comments2023-08-08T08:41:19.586-04:00Comments on The Medical Contrarian: Untended consequences of administrative payment schemes: A tale of two specialitiesThe Medical Contrarianhttp://www.blogger.com/profile/09240492315542223258noreply@blogger.comBlogger5125tag:blogger.com,1999:blog-2308282620289958037.post-23345888539899337042011-11-16T21:59:50.197-05:002011-11-16T21:59:50.197-05:00I agree with the e-doc that you are confusing valu...I agree with the e-doc that you are confusing value with inputs. You are not alone in confusing these two concepts. One of the great controversies of 19th century economics was between two schools of thought regarding where value comes from. One school thought value could be measured objectively through looking at inputs (objective school of value) while the other school viewed that value was completely subjective (subjective school of value). The objective school of value served as the intellectual underpinnings of the works of Karl Marx as well as the Resource based relative value scale. The subjective school of value is the basis of market based economies.The Medical Contrarianhttps://www.blogger.com/profile/09240492315542223258noreply@blogger.comtag:blogger.com,1999:blog-2308282620289958037.post-77565223893088271612011-11-16T17:46:13.831-05:002011-11-16T17:46:13.831-05:00Value is defined as outcomes divided by cost. Heal...Value is defined as outcomes divided by cost. Health care providers don't measure and catalog outcomes that matter most to patients--that is, 1) the cycle time and disease severity, 2)timing and severity of complications, 3)iatrogenic events, 4)recurrence of disease, 5)incidence of patient noncompliance, 6)quality of life, and 7)mortality-- over a full cycle of care...much less how much all that costs!<br /><br />Without that data, discussions regarding what actions/procedures bring more value to a patient are moot.e-dochttps://www.blogger.com/profile/04258216711169343595noreply@blogger.comtag:blogger.com,1999:blog-2308282620289958037.post-64599221485818351402011-11-16T10:18:44.033-05:002011-11-16T10:18:44.033-05:00Yes, but part of that value is tied up in the cost...Yes, but part of that value is tied up in the cost of performing that service. Surgeries and procedures require more overhead (techs, assistants, supplies, etc) so that is part of the increased perceived value.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-2308282620289958037.post-63588934416498825932011-11-15T19:22:21.068-05:002011-11-15T19:22:21.068-05:00As are the intricacies of diagnosing and treating ...As are the intricacies of diagnosing and treating any single complex disorder where the task is also completed over the course of many years, also taking into account any co-morbid states which may rear their ugly heads. <br /><br />We are in agreement that these represent complex tasks, the only difference being one set of tasks tends to be valued more highly through the payment system than the others.The Medical Contrarianhttps://www.blogger.com/profile/09240492315542223258noreply@blogger.comtag:blogger.com,1999:blog-2308282620289958037.post-73862203480549278782011-11-15T15:07:42.154-05:002011-11-15T15:07:42.154-05:00I would hardly say that subspecialization, example...I would hardly say that subspecialization, example hand sx fellowship following an orthopedic residency is any less complicated than maintaining a 'broad expertise' in medically managed illnesses. The intracacies of hand sx are by definition complex.Anonymousnoreply@blogger.com