Saturday, November 30, 2013

Your Doctor is Rated on Your Health

Through the Affordable Care Act, physicians will be publicly ranked for how well their patients are doing, especially if the patient is being paid for through medicare and the physician is in a relevant field.

For diabetics age 18-75, the physicians will be ranked on-

Whether or not your A1c is below 9%

Whether your blood pressure is high or not

Whether or not your LDL is low enough (<100 dl="" mg="" p="">
Whether or not you been examined for retinopathy in the past year.

Whether or not you have had a urine test for kidney disease in the past year.

Whether or not you've had an exam of your feet and ankles for neuropathy in the past year (it's unclear to me exactly how extensive they intend the exam to be).

Whether or not the doctor has looked at your shoes or other footwear to decide if it's safe or not.

Whether or not you have been tested for high blood pressure in the past 3 years (this one applies to adults up to 90 and not merely to 75).

Whether or not you meet ALL of the measures of a perfect diabetes patient: A1c below 8% PLUS blood pressure below 140/90 PLUS LDL below 100 mg/dl PLUS no smoking PLUS if you have heard disease, you're on aspirin

Whether or not you've had lipid testing in the past year.

If you have another doctor because of another disease, whether or not there is communication between the two doctors.

If you have a diagnosis of diabetic retinopathy and are any age, then whether or not the doctor has received proof of an eye exam in the past year.

If you have both a diagnosis of certain types of heart disease AND diabetes, then whether or not you have been prescribed a medication in the ARB or ACE inhibitor drug classes.

If you are 5-17 years old and have diabetes, whether or not your A1c has been tested in the past year.

And for all patients, the physician will be ranked based on things like what portion of patients have received a flu vaccine.

This ranking is theoretically intended to allow us to choose better doctors. But you can find even on the government website a list of reasons why this might not be a good idea- namely, your doctor will suddenly have an incentive to stop accepting or stop seeing patients that he has reason to believe will not look good for him. Also, this provides doctors with a reason to do unnecessary testing. For instance, there is really no good reason to test my lipids. Yet because my insurance company rates the doctor on these same things, my lipids have been tested annually for years. And guess what? Every year my TOTAL lipids is under 110 mg/dl and my LDL is under 50 mg/dl. That there is no point in testing the lipids of a person whose lipids were well below normal the previous year is not something that they take into consideration- as far as the writers of these standards are concerned, if I have diabetes, I must be at high risk of high cholesterol levels. Whereas I believe that previous lipid levels are a much better predictor, and that if the one test is not only not high, but below normal, there is no point in testing for high levels for another decade (or longer, probably).

Anyways. You can read or scan or search within the 1,369 page document here:

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