tag:blogger.com,1999:blog-2760353953251845523.post183303438904595879..comments2024-02-10T02:14:39.898-05:00Comments on Buckeye Surgeon: Comparative Effectiveness---- How effective is it really?Jeffrey Parks MD FACShttp://www.blogger.com/profile/15650563299849196122noreply@blogger.comBlogger1125tag:blogger.com,1999:blog-2760353953251845523.post-29571076943300742622010-02-14T12:25:38.347-05:002010-02-14T12:25:38.347-05:00First of all, I agree with you.
However this post...First of all, I agree with you.<br /><br />However this post actually discusses apples and oranges. Medicare's use of untested parameters (eventually found to be flawed) such as tight glucose control in ICUs has nothing to do with CER. It's really an indication of CMS's laziness in trying to devise P4P schemes.<br /><br />The most important part of CER is to get it right. As Groopman says, "best available evidence, accrued from rigorous scientific studies, ... to guide our decision making in clinical practice." <br /><br />Well done CER would be, IMHO, things reasonable physicians (like you and me) would advocate for our patients. Wouldn't you appreciate having a guideline that says end-stage dementia patients should not have PEG tubes inserted? Evidence is building that they do not benefit from them. And how many of your ICU beds are occupied by people whose suffering they are only prolonging? Might not well-studied guidelines offer support for YOUR style of practice, ie, letting terminal patients go, rather than "doing everything", just because we can?<br /><br />That said, I agree wholeheartedly that the government doesn't have a snowball's chance in hell of actually producing this kind of useful CER. Which means I agree with your concerns about being coerced to provide care that may ultimately be found harmful. Think there's any way we can avoid getting sued for it too? Me neither.#1 Dinosaurhttps://www.blogger.com/profile/01357845504444464397noreply@blogger.com