Showing posts with label New York City. Show all posts
Showing posts with label New York City. Show all posts

Sunday, January 13, 2013

New ways to measure the doctor's good deeds, and remunerate her or him in a better way ....

This article represents a big shift, at NYC's municipal level, from the easy-quantification way of paying  medical doctors in hospitals, to a system that is evaluative of the work of each doctorto determine how much financial reward he or she shoud get.  I see room for new forms of abuse in this paradigm, but I favour it because the old way was a shambles in inequity and iniquity.  What's more, "the new law could change longstanding relationships, giving more power to some of the poorest and most vulnerable patients over doctors who run their care."  I wrote about this from personal experience in the early days of this blog:  my six-part series near the launch of this blog, and which I can't find at the moment.  There doesn't seem to be an archive of back posts.  In any case, please read this NYT article by Anemona Hartocollis, as it may portend the future of medical remuneration of doctor's and nurses everywhere.

— Albert Gedraitis


New York City:  
Doctor's will get paid more for good care, less for lousy care





In a bold experiment in performance pay, complaints from patients at New York City’s public hospitals and other measures of their care — like how long before they are discharged and how they fare afterward — will be reflected in doctors’ paychecks under a plan being negotiated by the physicians and their hospitals.

The proposal represents a broad national push away from the traditional model of rewarding doctors for the volume of services they order, a system that has been criticized for promoting unnecessary treatment. In the wake of changes laid out in the Affordable Care Act, public and private hospitals are already preparing to have their income tied partly to patient outcomes and cost containment, but the city’s plan extends that financial incentive to the front line, the doctors directly responsible for treatment. It also shows how the new law could change longstanding relationships, giving more power to some of the poorest and most vulnerable patients over doctors who run their care.
“I would expect that we’re going to see this become more and more prevalent in compensation arrangements,” said Alan Aviles, president of the city’s Health and Hospitals Corporation, which runs the city’s 11 public hospitals and is the country’s largest public health system, handling more than 1 million emergency room visits a year.
The corporation’s plan would make doctors’ raises dependent on their performance on quality measures. The details are being negotiated with the doctors’ union, but both sides expect to reach an agreement that incorporates the idea.
Read more ...

Saturday, January 12, 2013

New York City's Mayor prescribes "suffer pain a bit" to stop pharmacy hold-ups

I coudn't  believe the crassness of the Mayor of New York City when questioned about new restrictions on the prescriptons of painkiller drugs by doctors.  First, he uses "death" as an example of suffering, but it isn't — not if you have painkiller prescription drugs up to and thru the moment of death.  After death, the body does not suffer, it dissolves.  So, why is the Mayor mixing apples and oranges?  Suffering of the body is not his to dish out, not his to encourage.  Only a sadist thinks that way.  Those in pain shoud not play masochist to his sadism.

Of course, I do realize that holdups of people coming out of pharmacies is a distinct problem in New York City, but in certain neiborhoods and not across the whole of Gotham.   The mayor'ss solution is no solution for those of us who don't have his kind of wealth.  He never has to go see a doctor or a pharmacy, in the first place, he can easily pay to have them come to him; or if he has to go to a pharmacy, he can take an armed guard or a squadron with him.  We can't.  So when he says that we can "suffer a bit," we must let him that we know that his plan to use us in that way is not acceptable.  He has to be fair to everybody, and he isn't succeeding with these S&M routines he's subscribing to the citizens in pain.

— Albert Gedraitis


Observer.com Politicker London UK (Jan12,2k13)

Bloomberg slaps down criticism of Painkiller Restriction Plan





Yesterday, Mayor Michael Bloomberg and city officials unveiled a new initiative to limit supplies of prescription painkillers in the city’s emergency rooms as a way to combat what they described as a growing addiction problem in the region. Some critics, as documented by The New York Times, however, felt the move would unnecessarily hurt poor and uninsured patients who use emergency rooms as their primary care doctor. Needless to say, Mr. Bloomberg was not swayed by this line of argument.
“The city hospitals we control, so … we’re going to do it and we’re urging all of the other hospitals to do it, voluntary guidelines. Somebody said, oh, somebody wrote, ‘Oh then maybe there won’t be enough painkillers for the poor who use the emergency rooms as their primary care doctor,’” the mayor said on his weekly radio show with John Gambling. “Number one, there’s no evidence of that. Number two, supposing it is really true, so you didn’t get enough painkillers and you did have to suffer a little bit. The other side of the coin is people are dying and there’s nothing perfect … There’s nothing that you can possibly do where somebody isn’t going to suffer, and it’s always the same group [claiming], ‘Everybody is heartless.’ Come on, this is a very big problem.”
In the same interview, Mr. Bloomberg stressed the initiative’s simple rationale is to prevent extra pills from piling up in the cabinets of New Yorkers who no longer need them, where they can pose a health risk if they’re abused.
“We talk about drugs, heroin and crack and marijuana, this is one of the big outbursts–and it’s a lot worse around the country than it is here. It’s kids and adults getting painkillers and using them for entertainment purposes, or whatever field of purposes, as opposed to what they are designed for,” he explained. “If you break a leg, you’re going to be in pain, nothing wrong with getting something that reduces the pain. But if you get 20 days worth of pills and you only need them three days, there’s 17 days sitting there. Invariably some of the kids are going to find them, or you’re going to take them and get you addicted.”
Mr. Bloomberg also argued the number of pain pills currently being prescribed had even contributed to an uptick in violent crimes outside of pharmacies from robbers looking to steal the drugs.
“You see there’s a lot more hold-ups of pharmacies, people getting held up as they walk out of pharmacies,” he explained. “What are they all about? They’re not trying to steal your shaving cream or toothpaste at the point of a gun. They want these drugs.”