Hah! This is what we have been waiting for! Economists are now borrowing from the education research literature to develop value-added metrics for physicians. Next, I hope, will be the development of VAMs for lawyers and soon you will hear the screams of outrage not only from the American Medical Association but the American Bar Association. With the economists figuring out metrics to measure these politically powerful professions, teachers won’t be alone in their battle against obsessive compulsive metrical disorder. If only someone would come up with VAM for elected officials! Better yet, how about a VAM for economists? For example, how often do their predictions about the economy come true?
Here is how you measure the value-added of physicians according to the link above from the National Bureau of Economic Research:
“Despite increasing calls for value-based payments, existing methodologies for determining physicians’ “value added” to patient health outcomes have important limitations. We incorporate methods from the value added literature in education research into a health care setting to present the first value added estimates of health care providers in the literature. Like teacher value added measures that calculate student test score gains, we estimate physician value added based on changes in health status during the course of a hospitalization. We then tie our measures of physician value added to patient outcomes, including length of hospital stay, total charges, health status at discharge, and readmission. The estimated value added varied substantially across physicians and was highly stable for individual physicians. Patients of physicians in the 75th versus 25th percentile of value added had, on average, shorter length of stay (4.76 vs 5.08 days), lower total costs ($17,811 vs $19,822) and higher discharge health status (8% of a standard deviation). Our findings provide evidence to support a new method of determining physician value added in the context of inpatient care that could have wide applicability across health care setting and in estimating value added of other health care providers (nurses, staff, etc).”
Diane Ravitch's blog 
Obviously, some kinds of physicians–pediatric oncologists, for example–are going to have very low value-added scores, because their patients frequently insist on not getting well. Any educational parallels there, anyone?
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I’m waiting for the argument that 1) Their professional organizations are too strong and need to be crushed, 2) pediatricians and lawyers who represent children’s interests should be paid less because they do it “for the children,” and 3) Ivy League grads with, say, 5 weeks of training should be allowed to serve as medical and legal practitioners in order to provide needed competition to spur on lazy docs & lawyers who just rake in high fees while their paraprofessionals do all the work.
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We already have a value added model for economists — have had one for millennia, in fact.
It’s the number “0”.
Economists are consigned to eternal VAMnation.
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“VAM for VAMmers”
VAM for VAMmers
Economists statted
Felt for hammers
Zero added
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So don’t treat high risk patients and people don’t have illnesses or injuries that don’t lead to quick and easy recoveries. Someone tell me why people keep listening to these idiots?
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Yes, many of us have been making these comparisons for years. Politicians whose constituencies live in poverty should be included in this mess so they can change their tunes on VAM.
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Good point LG! People living in poverty have less access to high quality health care.
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With VAM, what we see the corporate Charters doing with the at-risk and most difficult to teach children, reveals what most if not all doctors will do with the most at-risk patients—-Refuse to treat them!
Students are rejected by corporate Charters due to possible VAM outcomes.
Patients will be rejected for the same reasons.
Imagine, you have a terminal disease with a 5% chance of survival and not one doctor will be willing to work with you. You come in the front door and they slip out the back and run.
Medical centers that once took risks to treat patients with the lowest odds of survival, for instance, City of Hope, might close their doors because insurance companies won’t cover them with malpractice insurance. Instance companies will use VAMs to determine how much to charge doctors & hospitals and deny coverage to some.
Got EBOLA—sorry, go home and die.
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Lloyd…you are absolutely right. This ties in with Obamacare and the insurance industry. The insurance industry doesn’t want to part with any of their money if they don’t have to. Insurance is like a black jack game and when you bet against the house, the house ALWAYS wins.
If you don’t have a favorable outlook for any disease that you have, well it sucks to be you. Just go home and wait to die.
When the risks are too high in the medical field, you have doctors leaving in droves. The people who will be affected the most by dotors leaving the medcal field are the very people Obamacare is supposed to help.
The AMA is in the pocket of Obama anyway, so what they say isn’t relevant to the majority of doctors who do not agree with the AMA.
I have been in the health care field for over 20 years. More and more doctors are refusing to deal with this, with or without VAM, and are going to concierge medicine, which is basically you paying a fee to keep your doctor no matter what. If you don’t pay the fee, you don’t see your doctor, you see somebody else.
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Yes. And since the number if concierge patients is a fairly small population, look for more laws allowing non-MD treatment or more H1bs for overseas physicians.
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I’ve read of Americans who can afford it who go overseas for medical care to places like Thailand, China, etc. It’s cheaper and offers everything from doctors trained in the West and the U.S.
My wife visits China annually and that’s where she had her physical. The basic physical in China covers more ground than the U.S. for a fraction of the cost.
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I kept looking for the reference to The Onion but this insanity is real!
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This is what the oligarchs want, their money will buy them through their own difficulties, we are the excess people referenced in A Christmas Carol.
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“If they’d rather die, than they’d better do it, and decrease the surplus population.” Ebeneezer Scrooge
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Well, we all know that doctors are the main factor influencing a patient’s health. No more excuses for not being able to cure 100% of the patients 100% of the time!
Or in the words of John White, “Louisiana’s patients are just as healthy as those anywhere.”
It’s time to replace those lazy, rich doctors with DFA doctors – you know, the young, energetic, idealistic, high achievers who go through the 5-week crash course on medicine. They are the ones who hold the highest expectations that their patients will get well.
I’ll stop now – everyone knows the rhetoric.
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I think economists should be the next subjected to VAM. Perhaps there’s an economist around who could speak to that?
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I’ll bet we will see more PAs and RNs performing diagnostic care, treatment, and maybe relatively minor surgery. Also the infusion of technology into more medicine – high volume health kiosks, robotic surgery, intelligent software diagnostic systems. Go to a kiosk or your tablet, a medical person appears on a screen, you use a personal health device provided by insurance companies to upload your statistics, an AI program analyzes and recommends treatment, the multitasking medical person confirms, your script is delivered to your house by drone. And all of this data is tracked and marketed. The impetus is from insurance companies and their hedge fund investors to “bend the curve”. Of course, those “willing” to pay more, as Sen. Cruz and Ryan say, can obtain higher quality, personalized care from real doctors in a free market world. All of of this is possible today.
Notice “doctors” were only mentioned once in the last sentence.
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They already have concierge doctors that treat patients via Skype. I wouldn’t want to see them with anything serious, especially if the doctor says, “Either you have melanoma, we have a bad connection.”
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Robin Cook has a book out, Cell, that develops this scenario very well.
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Teachers may already know this, but “front line” doctors, family practice physicians, are really unhappy. If one talks to them about their work they sound a lot like public school teachers. They say their profession has been ruined by managers, that everything they value about the work is ignored by data freaks and MBA’s:
“We know that physicians who choose to enter family medicine do so because they feel the advantages outweigh those of other specialties. Researchers have found that students entering primary care are more likely to value interpersonal relationships, independence and public service over prestige or wealth.8 These values complement other factors that influence students to choose family medicine, such as a sense of altruism, favorable role models during training and the presence of family medicine clerkships in the medical school. In sum, students who place a higher value on relationships and independence are more likely to enter primary care, while those who place a higher value on wealth or prestige may be more likely to pick a subspecialty career. In reality, all physicians might want all of these things, but when pressed to choose one or the other, primary care physicians tend to sacrifice wealth and prestige for other values.
“Primary care has become a commodity” Sound familiar?
http://www.aafp.org/fpm/2006/0100/p15.html
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When I think of over-valuing economists I think of Larry Summers. I don’t know if any of you have read “Confidence Men” but I recommend it.
It’s a book about the Obama Administration’s response to the financial crisis, but it’s really a book about the completely irrational faith those in high levels of government have in people like Larry Summers. He was wrong about virtually everything over his career, but it didn’t matter. They kept hiring him and promoting him. They would have KEPT promoting him if Sherrod Brown hadn’t finally said “enough with this guy”.
It doesn’t matter how often they’re wrong. Makes absolutely no difference. Once they’re in the club they’re in the club forever.
It’s amazing to read. There was LITERALLY no concern for the “real economy”. The entire focus was on propping up financial markets and players. The only reason they were worried about unemployment was because it might cost them their jobs in an election.
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The vast majority of economists live in La La Land where “eternal (exponential) growth’ is not just a possibility but the preferred state.
They won’t/can’t even admit the existence of economic fraud because that would mean a renouncement of the unfettered free market.
Economics could be a Science if More Economists were Scientists
(By William K. Black)
And instead of focusing on cleaning up their own field (which is in dire need of “reform”), they “dabble” in everything from statistics (with VAMs) to climate science, making a complete mess of everything they touch.
And then they flatter themselves with fake awards (like the so-called “Nobel Prize in economics”, which is not even a real Nobel prize)
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Summers sounds a lot like Bush, the lesser.
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Economists like Paul Krugman and Dean Baker are a demand based voice of sanity in supply-side hysteria that merely makes the rich richer. Too many economists lose touch with reality or sell out to ideology first, then try to construct a rationale.
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I recall in the early years of the AIDS epidemic, Gary Trudeau decided to have the Andy character contract HIV. Andy’s doctor had a jolly sense of humor that he used to help his patients understand living with HIV even while accepting the inevitable. The doctor “bragged” that he had a “100 percent record with my patients. Yup, they’ve all died.”
I wonder what the VAM would be for those doctors who look past fear and fame for the greater good.?
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Highly effective physicians will be found to be treating the wealthy, who have access to better nutrition, better housing, higher income for preventative care, and less stress, and access to medical care due to speaking in the most commonly spoken language. Hmmm, why does this sound familiar?
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How about VAM for governors, legislators, and judges???? Currently in Ohio, they are valueless.
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I think we might have sort of a VAM for judges. In fact, we might have more than one. I used one of these sites for the 2014 election to learn something about the judges I was voting for.
Then for politicians, we have Vote Smart, but until they have a voting and speech/Op-Ed record, it’s difficult to tell what they think.
http://votesmart.org/
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Well, voting is supposed to change what needs to be changed, but when so many people don’t vote … then what do you do?
Also, people don’t care about any issue that they don’t understand. And some who vote seem that they are voting for one thing, but they are voting against their own interests.
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I wonder if any history, social studies, science or English teachers are teaching their students how to use the Internet to research candidates for elected offices and how to find information on the issues without bias.
I’m talking about Vote Smart, fact check sites, and sites that rank and compare judges through their verdicts. The tools/sites are there as long as the oligarchs don’t buy and corrupt them.
When I can’t find anything. I search for a candidates website and leave questions. I’ve even called campaign headquarters for a few and asked over the phone. When they don’t answer, I them I can’t endorse them on my Blogs or vote for them.
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Lloyd, we live in the gerrymandered John Boehner district. We tried very hard to unseat him, but there are so many people here who vote on issues of what they call political morality that a Democrat challenger (a very good one) couldn’t make a dent in the ads that Boehner’s crew ran. Money, money, money. Tom didn’t have that kind of money. People here think that if you vote for a Democrat you are backing baby-killers, lazy people, and atheists. It is difficult to put up with constant nonsense. Then, for governor, a guy who was virtually unknown ran against Kasich, and during the last week to replace a candidate, Kasich’s camp “exposed” the Dem for having no driver’s license for several years. That sunk his “credibility” and they couldn’t bring in another candidate. Great timing by the Reps. It is quite pathetic around here.
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No argument. There will be fools and sometimes the fools make up the majority. And its worse with Citizen United.
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The debate tends to be epistomological … and very difficult to move in a different direction … either way.
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I am personally conservative and don’t do a lot of things that a lot of people do, no matter what their politics may be. However, when I look at what Citizens United did to us … on top of the damage of “trickle down” into the pockets of the wealthy … I started looking at politics from a financial stance and from a view for others, for all, not for self. For, without a collective goal for everyone, all but the few are endangered by the greed of those few. Some worry that our morality has gone down the tubes, and possibly it has, but if we can’t find a way to survive, thrive, and live together, the great American experiment will fail. Everyone can’t have his/her own way for self. But, if we wish to put a blind eye to what is happening by choosing to plug our ears and sing, “lalalala laaaa laaaa” we can avoid facing our responsibilities. But, as I am learning, this has to do with epistemological differences. Not easily modified.
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VAM for economists, they are all worthless in terms of public policy, why should we listen to them?
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This CBS piece sums up the reliability of using a VAM on economists:
Many gurus rely on economic forecasts when telling you where the market is going. However, these forecasts (much like the market predictions) are really nothing more than guesses.
The majority of economists didn’t “predict” the three most recent recessions (1990, 2001 and 2007) even after they had begun.
In November 2007, economists in the Philadelphia Federal Reserve’s Survey of Professional Forecasters called for growth of 2.4 percent for 2008, with only a 3 percent chance of a recession, and only a 1 in 500 chance of the GDP falling by more than 2 percent. GDP actually fell 3.3 percent.
Since 1990, economists have forecasted only two of the 60 recessions that occurred around the world a year in advance.
http://www.cbsnews.com/news/why-you-should-ignore-economic-forecasts/
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I’m sure I’m not the first one to take a crack
at this parody (SEE ABOVE)
But what about “DFA… Doctors for America”?
They’re so much better and a lot cheaper than
those current doctors we have—and cost
the school leaders less—because they
never went to one of those
expensive so-called “medical schools” (or
they dropped out halfway through).
After all, medical school grads have to be paid
so much more, even when we know they’re not
that all that great, as determined by the ‘data’.
Instead, DFA’s unlicensed, (or alternatively-licensed)
care-providers merely went to DFA’s Summer
Institute, a short five-week ‘alternative certification’
medical program. (Oh and they leave medicine after
two years to move on to another career.)
Sure, it’s just a short 5-week ‘crash course’, but look
at how their data/results/patient outcomes
outdo that of those expensive, but low-performing
licensed med school grad, with all their high-falutin’ but
useless…
— ‘M.D. degrees’,
— ‘four-year
residency programs’,
— ‘internships at the Harvard Medical
School.
— ‘attending-ships at the Mayo Clinic’, etc.
Don’t you see? This just proves how useless
all that expensive education and extra salary
that M.D. physicians get is, and what
a waste of money it is for taxpayers to
pay them for it.
Don’t take my word for it. Check out the findings
of the National Council on Doctor Quality (NCDQ).
This independent (!!!) think tank has
studied—but not actually visited—
the nation’s medicals schools. Now while they
haven’t gone in person to see what happens
in medical schools—witnessed classes in
progress, interviewed the teachers,
students, graduates, etc.—they’ve reviewed
their syllabi that have been posted on-line…
and from that, they can tell that medical
schools are a complete failure,
and should be eliminated, in favor of
“alternative doctor training and licensing”
Indeed, medical school training of doctors
is “worthless”…
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LOL
For the DFA, they could follow China’s model for the bare foot doctors program during Mao’s era in China—that ended decades ago. This way even illiterates could become a DFA. All they have to do is watch a bunch of 20 minute films on how to handle different health challenges for their patients. They probably had a film for how to remove a burst appendix too. My wife says these guys were allowed to conduct surgeries and if there was no electricity to run the projector, then they had these cartoon pamphlets to guide the illiterate bare foot doctors during a surgery.
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That’s too horrifying to even imagine… Yikes!
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Like Bob once said,
“And, if these idiot technocrats wanted to apply real learning from business measurement to education, they would do well to scrap VAM and think, instead, in terms of worker-directed continuous quality control of the kind implemented, famously, in the Japanese auto industry, in which the workers on the line did their own evaluations, in concert, and were rewarded for their successful innovations (rather than having their autonomy removed and being themselves robotized). The great pioneers of quality control–William Edwards Deming and Joseph Moses Juran, were first and foremost humanists. They understood that work is done by humans and that humans require autonomy and intrinsic motivation. Key principles of Deming’s Total Quality Management movement included “Drive out fear, so that everyone may work effectively,” “Eliminate slogans, exhortations,and targets for the work force asking for zero defects and new levels of productivity” for “such exhortations only create adversarial relationships,” “Eliminate work standards (quotas) on the factor floor,” “Eliminate management by objective,” “Remove barriers that rob the worker of his [or her] right ot pride of workmanship.”
People who know nothing of the history of industrial quality control and of its astonishing successes will be surprised to learn that such learnings as these are what the engineering types who studied quality improvement in the workplace and turned it into a true science came to. Exactly the opposite of what these idiot technocrats are now doing in our schools. Amusingly, the technocrats aren’t even familiar with the basic principles of modern industrial management, which run precisely counter to all that they are doing.”
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“Patients frequently insist on not getting well.”
I am not certain I am up to examining the parallels with VAM and the destruction of public schools. I know that insurance companies are doing a number on the physicians, and the insurance companies, in turn, are not entirely free agents especially with respect to Medicare, Medicaid, and Obamacare where (in theory) there are some regulations and inspections of records for fraud and abuse.
Although students and parents seem to be at risk from a deregulated market in charters and from dysfunctional public schools, most states still have compulsory attendance laws and a guaranteed subsidy for education. There is ample evidence that charter operators are cherry picking clients/patients (taking the “healthiest) from a large pool of clients/students/parents not now being accommodated in communities where support for really good schools is reasonably assured. So many charters are engaged in bottom feeding, seeking profits among the least able and those who are being hammered with accounts of their “failing schools” and failing students.
Some charters seem to be operating very much like the hospice care industry–for profits in particular. Here is the lay-of-that-land
For-profit and non-profit continuing care facilities with a skilled nursing facility have the equivalent of a value-added measure. Patients who do not respond to treatment after X number of days and Y number of interventions are converted to Hospice care—for-profit or non-profit—both sustained by guaranteed fees from Medicare or Medicaid. Hospice care corporations seek “priority ” relationships with continuing care and skilled nursing facilities for a supply of clients/patients. The Hospice care “industry,” like the education industry thrives when there are markets, low-risks of losing money, and little regulation. Unlike Hospice patients, students don’t just go away and most are not yet of age.
For some appauling facts and figures on Hospice Care from a Huffington Post investigative series go to http://projects.huffingtonpost.com/hospice-inc
Meanwhile mega-pharmaceutical companies devoted to order-fulfillment exclusively for continuing care and hospice facilities make a bundle with markups. Continuing care facilities (for profit and non-profit) depend on the so-called discounts offered for bulk purchases.
These discounts are not passed along to the accounts for patients.
Billing issues that may arise are handled by huge call centers where opportunities for creative fraud are huge. PharMerica is one of these, charged with dispensing schedule II drugs without MD authorization, and now if federal court. Not many court cases on fraud and abuse in charters. Frauds in public schools are really pounced on by the media.
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In addition to VAM for doctors, I think we should start HFA: Healing For America. We can recruit graduates of Ivy League colleges and other universities, give them an intensive, five-week training course over the summer, then let them provide health care in clinics and community health centers across the nation. Some medical school graduates who spent years in residency programs might complain about the HFA doctors being unprepared, but it won’t be that big of a deal, since they’ll only stay in a clinic for two years or so. After their two years of playing doctor, they will be very attractive job candidates for health insurance companies and big pharmaceutical corporations.
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“Leech for America”
Leech For America
Crackpot physicians
Five week training
For leech impositions
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yes.
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As a result of the ACA some physicians received grants to enable them to comply with the data management plan. My internist spent most of my visit rolling back and forth on his chair between his IPad and computer and fussed around trying to get on the right page. He hardly noticed I was there, other than to ask me questions with his eyes firmly planted on the electronics.
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I have seen this same thing, more than one MD
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“With the economists figuring out metrics to measure these politically powerful professions. . . ”
Those economists haven’t been and aren’t “figuring out metrics to measure” nothing. It’s all a bunch of “pseudo measures” that have a veneer of statistical machinations that make their bullshit appear to be valid. It’s not scientific and it’s not valid no matter how much psychometric and econometric blatherings they use.
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Any of the economists “formulas” (bullshit) that is not open to scrutiny, and most aren’t publicly available, should be looked upon with utter disdain.
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Agreed.
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Reblogged this on David R. Taylor-Thoughts on Texas Education.
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i think “VAM” is creeping into our medical community more than the public at large is aware of. I went to a large drugstore chain walk in clinic a while back and wound up having a simple cold. The NP told me I should use two prescription medicines (one for the nose and one for the throat). I mentioned I did not feel I needed this for a basic cold so not to bother writing a prescription. The NP said she would do it anyway. I asked her why as I did not want it. It came out that she is REQUIRED to write a prescription for these meds or else will have repercussions with her employer. Upon reflection, I realized that the very same medicines had been suggested at another walk in center I had gone to the year before! From now on I will stick to my own DR office! But is this going to happen there too soon? Our walk in medical facilities have their own “rubrics”… they seem to have some “deal” with pharmaceutical companies and are irresponsibly writing up prescriptions… this totally takes control away from what a medical professional would suggest or even the medicines (if any) that he/she would choose to offer a patient! Perhaps part of this NP’s “VAM” is how many prescriptions for specified drugs she writes each month… a sales quota! I ripped up the prescription as she handed it to me. But no mistake… this is extremely troubling.
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I don’t know about “VAM” ratings of physicians per se, but it would be more or less consistent with the big picture in the health care industry, which is heavily influenced and/or controlled by the insurance industry, which itself is the birthplace of the statistics-driven business model. Statistical models were guiding health care decisions long before VAM ratings showed up in education.
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It sounds like the opposite of what Obama proposed. He wants to move from a “pay for procedure” to an “outcome” model. It sounds like Big Pharma is having its way prescribing unnecessary medications.
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My GP, who is wonderful, is married to a teacher who is now a principal. He gets VAMmed from both sides. At my recent visit, he explained that he needs patients to follow his recommendations or he gets dinged in his ratings score. I sure hope he doesn’t get dinged for dying patients because his area of interest is geriatrics. He spends as much time as he needs to with his patients and makes them feel valued. No one is asking me about his competency or bedside manner. Both are wonderful I might add. Healthcare professionals ARE being VAMmed.
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Yes, health care professionals, not the lawyer administrators, are indeed being VAMMED, just like teachers. It’s totally ridiculous.
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Reblogged this on peakmemory and commented:
“If only someone would come up with VAM for elected officials! “
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