VBC is not a "Care Model"
#VBC is a business contract. My simulation shows how contract terms make #ACO survival nearly impossible. Adust the contractual terms and see the effect on ACO survival.
https://t.co/d6iMfiIwFL
#HealthcareFinance#HealthPolicy
@molsjames Here is a table that shows the David vs. Goliath battle in healthcare.
I wrote this in the context of how Value-Based Care increases the total cost of care.
https://t.co/j303PR3LUH
@DrDiGiorgio@constans This is the piece most people don’t understand. And it's also one of the reasons why many docs keep working past 65.
Delayed gratification and delayed retirement.
@DutchRojas Not just denied, insurance can take it back from the physician 2 years later, you know, because the patient forgot to pay their premium and were not covered on date of service - which the insurance conveniently did not update their system to let us know.
@krishnanrohit Look up Bayes theorem and its counterpart in medicine - Positive and Negative Predictive Value.
Then pls read my articles:
https://t.co/4fD6RQ4gQE
https://t.co/2AFSuZWNFb
@SaraForTexLege@grok calculate the NNT of statins, cost of prescription, annual physicals and labs to monitor statins are over a 20 year period. Also add cost of additional visits/labs due to statin side effects. Compare that to cost of hospitalization for heart attack.
We have diseconomies of scale and rationing in healthcare in the US
The only difference is that private companies do it here for profit, whereas governments do it to avoid raising taxes.
A lot of this would be solved in a market based system + safety net system.
Pick your poison.
@MichaelAlbertMD Equally, if not more important than sensitivity and specificity in clinical care is understanding Positive and Negative Predictive Values.
And they depend on the pre-test probability of disease!
@DrAdamBat There is fair amount of patient selection bias.
People who were really worried and scan was negative, were relieved.
However, if there were incidentalomas, they may end up in a worse situation.
Tradeoffs!
@DrDiGiorgio Also, if you participate in insurance, they make it very hard contractually.
I have to start all over and rebuild my panel with people willing to pay out of pocket.
Chicken and egg problem.
@DrDiGiorgio The only thing stopping me is that my practice is currently part of an IPA that contracts with private insurance.
Because of all the private insurance shenanigans, I am debating whether to keep only Medicare & Medicaid and stop accepting all private insurance.