5 ms·

Forgive me if I'm mistaken, but isn't a "procedure" something that is well documented set of steps to be taken to remedy a person's ills or assess what is actua

Forgive me if I'm mistaken, but isn't a "procedure" something that is well documented set of steps to be taken to remedy a person's ills or assess what is actually wrong with the patient (ie. mri, xray, etc) ? Sure, like with anything, there may be some unknowns that cause some variations in the implementation of the procedure, but it's likely a valid (in most cases) way to track performance and control costs. If some hospital is regularly charging 2 standard deviations more than other hospitals for same procedures, that seems it would be a red flag. Or if a doctor is regularly taking 2 standard deviations longer to perform same procedures as the rest of his/her peers, that's a red flag.

fluidcruft 11y ago
> if a doctor is regularly taking 2 standard deviations longer to perform same procedures as the rest of his/her peers, that's a red flag FYI defining the "peers" part of that calculus is the hard part. Physicians choose their patients. Those that choose low hanging fruit do quite well in metrics. It doesn't require much skill to pick low hanging fruit. It turns out that those who are good at picking fruit from the top of the tree, tend to be called on to pick fruit from the top of the tree. Individual procedure codes in no way communicate anything about difficulty.
- datashovel 11y ago
  I hear you for sure. I think similar concepts apply in most non-trivial pursuits. I'm certain I can't generalize across the board, but typically my assumption would be that the person who is "better" or more experienced with certain things are getting the more difficult cases, and so perhaps by either separating them with a "senior" or "specialist" title and different pay scale they're not being graded on the same curve as people who are handling the more routine cases. Ultimately I think those edge cases can be fleshed out and monitored with regular auditing.
  - pixl97 11y ago
    > but typically my assumption would be that the person who is "better" or more experienced with certain things are getting the more difficult cases, You sure about that? I also use my experience to filter out clients that are going to be a huge pain in my tail. When I was less experienced I ended up with some jobs that were huge messes because I didn't see the warning signs. Now that I can better predetermine the work involved I can choose not to take the job, or I can correctly tell the client the job will be much harder than it actually appears to be.
    - datashovel 11y ago
      I think we're talking about different things. I too do my best to weed out potentially troublesome clients. But when a larger group of people have a "body of work" they're responsible for, that's the sort of hierarchy I would expect. In the long run, though, I think (in an open market system) always turning down hard cases (for example referrals from peers, or people who specifically seek you out for your expertise) can negatively affect your reputation. In the end I might call it a wash because the person who is truly trying to do the least amount of work for the most personal benefit wouldn't try to stand out by finishing their work substantially faster than their peers or charging substantially less. So you probably lose a lot of the marketing benefit of out performing your peers since your ideal scenario will be to remain hidden in the pack. And by doing, it seems reasonable to assume people won't be trying to knock down your door to get you to do work for them like someone who is accepting the more challenging work and doing so successfully.
      - fluidcruft 11y ago
        Free markets are many things, but they are never meritocracies without the assumption that capital is merit. Whoever has the most money always has the best marketing.
        datashovel 11y ago
        I may be more cynical than the average person on this, but I have to believe, for the sake of human kind, :) that even the casual observer today doesn't believe capital is merit. At least not as a broad generalization. However of course people who are good at what they do generally have more opportunities to make more money than those who are not.
- emodendroket 11y ago
  On one hand, you're right, but on another there do seem to be some "objective" measures of quality too -- for instance, hard patients or not, sowing up a patient with a sponge left in them is a serious error (that is also not all that uncommon, unfortunately).
  - fluidcruft 11y ago
    Quite often, these sorts of medical errors are reduced significantly by adopting risk and personnel management practices that were learned from a dark chapter of air traffic control. These practices don't mesh well with the current procedures performed compensation structure which is one of the reasons that developing new reimbursement models is en vogue. The status quo has enough inertia that it takes a major mishap to get each institution's bureaucracy to react.

fluidcruft 11y ago

> if a doctor is regularly taking 2 standard deviations longer to perform same procedures as the rest of his/her peers, that's a red flag FYI defining the "peers" part of that calculus is the hard part. Physicians choose their patients. Those that choose low hanging fruit do quite well in metrics. It doesn't require much skill to pick low hanging fruit. It turns out that those who are good at picking fruit from the top of the tree, tend to be called on to pick fruit from the top of the tree. Individual procedure codes in no way communicate anything about difficulty.

datashovel 11y ago
I hear you for sure. I think similar concepts apply in most non-trivial pursuits. I'm certain I can't generalize across the board, but typically my assumption would be that the person who is "better" or more experienced with certain things are getting the more difficult cases, and so perhaps by either separating them with a "senior" or "specialist" title and different pay scale they're not being graded on the same curve as people who are handling the more routine cases. Ultimately I think those edge cases can be fleshed out and monitored with regular auditing.
- pixl97 11y ago
  > but typically my assumption would be that the person who is "better" or more experienced with certain things are getting the more difficult cases, You sure about that? I also use my experience to filter out clients that are going to be a huge pain in my tail. When I was less experienced I ended up with some jobs that were huge messes because I didn't see the warning signs. Now that I can better predetermine the work involved I can choose not to take the job, or I can correctly tell the client the job will be much harder than it actually appears to be.
  - datashovel 11y ago
    I think we're talking about different things. I too do my best to weed out potentially troublesome clients. But when a larger group of people have a "body of work" they're responsible for, that's the sort of hierarchy I would expect. In the long run, though, I think (in an open market system) always turning down hard cases (for example referrals from peers, or people who specifically seek you out for your expertise) can negatively affect your reputation. In the end I might call it a wash because the person who is truly trying to do the least amount of work for the most personal benefit wouldn't try to stand out by finishing their work substantially faster than their peers or charging substantially less. So you probably lose a lot of the marketing benefit of out performing your peers since your ideal scenario will be to remain hidden in the pack. And by doing, it seems reasonable to assume people won't be trying to knock down your door to get you to do work for them like someone who is accepting the more challenging work and doing so successfully.
    - fluidcruft 11y ago
      Free markets are many things, but they are never meritocracies without the assumption that capital is merit. Whoever has the most money always has the best marketing.
      - datashovel 11y ago
        I may be more cynical than the average person on this, but I have to believe, for the sake of human kind, :) that even the casual observer today doesn't believe capital is merit. At least not as a broad generalization. However of course people who are good at what they do generally have more opportunities to make more money than those who are not.
emodendroket 11y ago
On one hand, you're right, but on another there do seem to be some "objective" measures of quality too -- for instance, hard patients or not, sowing up a patient with a sponge left in them is a serious error (that is also not all that uncommon, unfortunately).
- fluidcruft 11y ago
  Quite often, these sorts of medical errors are reduced significantly by adopting risk and personnel management practices that were learned from a dark chapter of air traffic control. These practices don't mesh well with the current procedures performed compensation structure which is one of the reasons that developing new reimbursement models is en vogue. The status quo has enough inertia that it takes a major mishap to get each institution's bureaucracy to react.