Evidence Based Medicine Fact vs. Myth

©2005 Bilao LLC

Evidence Based MedicineEvidence Based MedicineFact vs. MythFact vs. Myth

Richard O. Dolinar M.D.Richard O. Dolinar M.D.

©2005 Bilao LLC

Quality Based Purchasing

I.I. Evidence Based Medicine – the foundation Evidence Based Medicine – the foundation

II.II. Best practices – the standardBest practices – the standard

III.III. EMR – the monitorEMR – the monitor

IV.IV. Outcomes Measurements – the gaugeOutcomes Measurements – the gauge

V.V. Pay for Performance – the enforcer Pay for Performance – the enforcer

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I.I. Evidence Based Medicine Evidence Based Medicine – the foundation– the foundation

A.A. Definition of evidenceDefinition of evidence

B.B. External validityExternal validity

C.C. Evidence based?Evidence based?

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““Evidence based medicine is Evidence based medicine is managed care masquerading as managed care masquerading as science.”science.”

Twila Brase R.N.Twila Brase R.N.

President of the Citizens Counsel on HealthcarePresident of the Citizens Counsel on Healthcare20052005

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II.II. Best Practices – the standardBest Practices – the standard

A.A. Group vs. individual bestGroup vs. individual best

B.B. Algorithms replace medical judgmentAlgorithms replace medical judgment

C.C. Mistakes institutionalized Mistakes institutionalized

D.D. The problem of knowledgeThe problem of knowledge

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D.D. The problem of knowledge:The problem of knowledge:Clinicians practicing medicine apply Clinicians practicing medicine apply prudent decisions in reaction to ever prudent decisions in reaction to ever changing circumstances that only they changing circumstances that only they can know.can know.

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In Reality:In Reality:The “Best Practice” is to The “Best Practice” is to treat patients according treat patients according to their individual needsto their individual needs

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III.III. Electronic Medical Records Electronic Medical Records – the monitor– the monitor

A.A. Cost effective vs. cost prohibitiveCost effective vs. cost prohibitive

B.B. An accurate portrayal of patient An accurate portrayal of patient care?care?

C.C. Benefits whom?Benefits whom?

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IV.IV. Outcomes Measurements – the gaugeOutcomes Measurements – the gauge

A.A. Measurements could appear to be Measurements could appear to be improving but in reality things could be improving but in reality things could be getting worsegetting worse

B.B. Physicians vs. patient outcomesPhysicians vs. patient outcomes

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V.V. Pay for Performance - the enforcerPay for Performance - the enforcer

A.A. Pay for compliancePay for compliance

B.B. Responsibility without powerResponsibility without power

C.C. Fruits/vegetablesFruits/vegetables

D.D. Physician misclassificationPhysician misclassification

E.E. SGR/No new moneySGR/No new money

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““Analyzing patient data, measuring physician Analyzing patient data, measuring physician performance, and calling the process performance, and calling the process “scientific” is the mechanism being used “scientific” is the mechanism being used today to shift power and control away from today to shift power and control away from

physiciansphysicians.”.”Gary BelkinGary Belkin

20042004

Pay for performancePay for performance

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A buys from BA buys from BC paysC pays

Modified from reference: Kleinert, Richard. Deloitte Consulting LLP Human Capital Practice. WARD’s Auto World, February 2005. 1965 House of Representatives Minority Report regarding the financing of Medicare

Evidence Based Medicine Fact vs. Myth

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