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On Paying 4 Performance
@pocket-witch You would think, and in many cases it is incentive enough. But there are a variety of factors that make it far from universal: 1)rapidly changing guidelines combined with over-worked and under-staffed primary care providers making it hard to keep up with what is best in what situation 2)overlapping conditions that can cause contra-indications for medications and treatments but can be overlooked due to above mentioned reasons (and also, could be unknown to the provider because patients tend to move around a lot. Especially the really sick ones). 3) A system that prioritizes volume and de-emphasizes holistic care. 4) Plain old arrogance Many times the provider has the patient's best interest at heart but our system tends to make it difficult to care for the whole patient and not for the condition. And @deepomega, as far as alternatives are concerned, Health Information Exchanges, Patient Centered Medical Homes and Accountable Care Organizations are making recent headway into ensuring that a patient is cared for across disciplines. The emphasis there is on the QUALITY of care, rather than the volume, so it's a step in the right direction.
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On Paying 4 Performance
@anecdata I know! Me too. But this is what I DOOOOO. Good ol healthcare policy. I hate that it's so screwed up, but I do appreciate that it means GREAT job security for me... But yes, in general no one thinks that P4P is perfect, but it does have great potential to lower costs by changing the culture of over billing. It's a start, anyway.
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On Paying 4 Performance
@deepomega in addition, the current system does little to assure care of patients and much more to assure unnecessary testing. Procedure based billing simply encourages running MRIs "just to make sure" and then being able to bill for them. Regardless of whether or not it was necessary. ALSO "Knowledge gaps" are IMPROVED with P4P because if the doctor has to perform on something, she is more likely to know about it. The P4P programs outline necessary procedures for both chronic care and preventative care and are updated yearly to account for latest standards of care. That's not to say they're perfect, but they shouldn't be demonized.
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On But Wait, Now How Will I Discover Terrible New Dining Establishments I'll Visit Once And Never Return To?
@Reginal T. Squirge Have you seen the commercials for Coupon Suzie? I had to rewind it 3 times just to make sure she wasn't saying "Poop on Suzie"... so maybe say "queue-pon" if you would like to avoid folks randomly defecating. For the record, I like to mix it up. Life is too short to pronounce words just one way. Or something.
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On The Wedding Dress Markup
No! Mike Dang! I (a female) chose one of those J.Crew dresses for under a grand (on sale for $225, actually) and I found someone to marry me! Wedding dress mark up is The Worst.
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On Places Where I Have Lived
it thrills me to no end that other adult people have had 10+ post-college dwelling places.
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On Open Thread
@sunshine@twitter I used to have a similar situation and I started bringing grounds and a large French press(cheap at IKEA) and making my own. Most of those ancient coffee makers have a hot water spout and if not, the microwave will work in a pinch, just bring something without metal to heat it up in. Good luck!