Monday, January 21, 2008

Double standard? You be the judge.....

Isn’t a shame that this personalized care engagement strategy doesn’t get more respect? Advocates have pointed out that participants benefit from six key components:
  • identification processes that identify important clinical conditions
  • application of evidence-based clinical guidelines
  • the participation of other skilled healthcare providers
  • high quality, personalized patient education
  • ongoing data storage for use in outcomes evaluation and
  • performance feedback

Thought I was talking about disease management? Not exactly.

The summary above is also about the annual physical examination, which is supposed to 1) uncover treatable conditions, 2) apply only the best science for prevention and treatment of those conditions, 3) initiate and coordinate appropriate care with other healthcare providers, 4) inform patients about their best care options, 5) establish a complete and retrievable record and 6) create a baseline against which future health can be measured.

If we fairly applied the tone of many reviews about disease management to the time-honored yearly check-up, it might read something like this:

Skeptics have raised doubts about the annual physical exam in the medical literature. There have also been reports from highly respected sources that have extensively reviewed the available evidence and concluded it has failed to demonstrate that it has any consistent value. While other studies indicate it may or may not actually increase quality, its cost amounts to billions and the absence of any good studies on a return on investment makes one wonder if the physical examination industry is intentionally misleading us. Market demand for the annual examination is high however, which has been forcing many commercial health insurers to ignore their actuaries’ advice and pay for it.

Physicians have their unbiased perspective on the topic. Good thing the U.S. Congress and CMS routinely, uniformly and fairly apply a scientifically rigorous process to controversies like this before covering it under the standard benefit.

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