There are three problems with healthcare incentives and they all revolve not around the stated goal of pay for performance, but around the atmosphere that incentives produce.
Everyone wants to improve healthcare outcomes (or should) and providing incentives which reward physicians for achieving these goals would appear to be a good thing, but as is usually the case, the devil is in the details.
Problem #1: The commoditization of healthcare
When I went to medical school, we were taught that “good medicine is the best defense.” This meant that the reward for good medicine is practicing good medicine. Yes, doctors made a good living, but that living was not a reward for good medicine, but a reward for being a good doctor with all that the term “good doctor” entailed (competent, caring, compassionate, etc.) Changing the emphasis from “good medicine” and “good doctor” to dollar signs simultaneously changes healthcare from a service and a calling to a commodity to be bought, sold, and squandered.
Problem #2: Goals created in a vacuum
“Best practices” and “treatment goals” are the end points and rulers against which physician performance are measured in a “pay for performance” environment. These “best practices” and “treatment goals” are based on the conclusions of scientific studies. Patients enrolled in scientific studies typically suffer from only a single illness, the one that is being studied. In fact, the scientific method requires that patients be “normal” in all other ways. This is why subject recruitment is so difficult in scientific studies.
The problem is that in real world medicine, most patients have more than one illness. (An old medical “law” known as Silvagni’s law reminds us that there is no law in medicine that states you can’t have more than one problem at a time). It is not uncommon to have a patient with multiple diseases and find that the multiple sets of “best practices” that are incompatible. Of growing concern is the effect of polypharmacy (multiple prescription medications) which is the natural outgrowth of attempting to comply with all the “best practices” for a single patient with multiple diseases.
Problem #3: The mechanization of medicine
A growing trend in certain practice environments is the use of non-clinical, non-healthcare benchmarks to evaluate physicians. We are all familiar with “patient satisfaction surveys” which are actually exit polls. A survey is a scientific sampling of a representative subset of a larger group. An exit poll is the interrogation of everyone at the end of the care encounter. In a survey, if a person of a particular demographic fails to respond, they are replaced by another person with the same demographics. In an exit poll, if someone fails to respond, there is no one to replace them and thus the entire context of the poll changes. In a survey, if the representative demographic group is not recruited, the survey is invalid. If an exit poll has poor response, the results are still reported, even though they are invalid. Since those who are disgruntled for any reason are four times more likely to respond to an exit poll than those who are satisfied, the results are always skewed against the healthcare provider. This results the modification of medical practice to improve scores, not care. Towards this end, many emergency rooms are offering guarantees regarding wait times and even how long it will take to be treated.
Emergency room directors in these institutions are forced to encourage ER physicians to “just get face time in as many rooms as possible as quickly as possible, then get history and physicals later.” I personally have heard this in several ER’s and in only one was this advise part of an effective plan that positively impacted patient care and outcome. In all other situations, this admonishment was given to ensure that “the times look good.”
The purpose of a DOCTOR is to provide the best medical care possible within their skill set and after a scholarly and objective review of the literature. The measure of a PHYSICIAN is the ability to perform the functions of a doctor with humanity, humility, caring, compassion and love. Perhaps we should find a way of incentivizing physicians, not doctors.
Griffin Works offers Pawsitive Interactions with Service Dogs During Response Operations©, an audience-customized training that breaks down barriers by offering hands-on handling training and demonstrations with working service dogs for fire departments, EMS agencies, and public safety organizations.
Part of the National Domestic Preparedness Consortium and home to the National Emergency Response and Recovery Training Center, TEEX has been leading homeland security training since 1998. The major TEEX programs include fire and rescue, infrastructure and safety, law enforcement, economic and workforce development, and homeland security. As a member of The Texas A&M University System, TEEX is unique in its ability to access a broad range of emerging research and technical expertise. Beginning with course design and development all the way through hands-on instruction and national certification testing, TEEX delivers comprehensive training through both classroom and hands-on instruction and as online courses.
The National Child Traumatic Stress Network (NCTSN) was created by Congress in 2000 as part of the Children’s Health Act to raise the standard of care and increase access to services for children and families who experience or witness traumatic events. This unique network of child-serving professionals, caregivers and young adults, researchers, and national partners is committed to changing the course of children’s lives by improving their care and moving scientific gains quickly into practice across the U.S. The NCTSN is administered by the Substance Abuse and Mental Health Services Administration (SAMHSA) and coordinated by the UCLA-Duke University National Center for Child Traumatic Stress (NCCTS).
The Emergency Management Institute (EMI) is part of the Department of Homeland Security’s Federal Emergency Management Agency (FEMA). The EMI provides national leadership in developing and delivering training to ensure that individuals and groups having key emergency management responsibilities possess the requisite skills to effectively perform their jobs.
The High Alert Institute maintains a list of reviewed courses provided by governments, universities and professional organizations. This list is geared towards the non-emergency management person who participates in disaster planning, preparedness, response, recovery or mitigation as part of their job responsibilities.
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Koi need forever homes, too! For pond enthusiasts, freshwater exotic and ornamental fish may not be available through pet stores or rescues in their area. The High Alert Institute Aquatic Pet Shelter Rehoming Program will be happy to assist you in stocking your new pond or adding a new finned friend to your school. Coming soon – when you adopt a Koi from the High Alert Institute Aquatic Pet Shelter Rehoming Program, we can arrange for delivery to your door anywhere in the continental United States.
Have you always wanted a Koi pond but don’t have the space one? Sponsor a Koi in our community shelter pond and we send you photos of your sponsored animal. Coming soon are live Koi Cameras above and below the water to enjoy your sponsored Koi anytime.
Dumping of freshwater non-native species and exotic aquatic pets into wild habitats is a man-made disaster that is truly preventable. The Institute’s Aquatic Pet Welfare Partnership works to raise awareness and reduce the impact on healthy ecosystems through education, as well as rescue and rehoming. Joined by champions of animal welfare and environmental stewardship, this association of aquatic pet rescue operations and aquatic pet shelters across the United States aims to save our finned friends and preserve our waterways together.
Want to share our cause with family, friends, and colleagues? Looking for a non-traditional way to celebrate a birthday or honor someone special? Support the Institute by starting your own Peer-to-Peer fundraising challenge! Let your contacts know why our mission is important to you and what they can do to support your cause. START YOUR OWN FUNDRAISER for the High Alert Institute.
From the staffing pool to the shelter ponds, from the boardroom to the classroom, and from reading the science to writing the analyses, High Alert Institute programs and services benefit from the experience, expertise, and generosity of our volunteers. Put your talents to use for good and to good use – VOLUNTEER TODAY.
Make your donation twice as nice by rehoming aquatic pets and providing a rehabilitation companion pet to a deserving person, family, or facility. Sponsor part or all of a Joy of Koi Program pond installation – complete with rehomed koi – and give the gifts of love and recovery.
Professional photographers, amateurs, and legal copywrite holders are all welcome to participate in the High Alert Institute Nature Photo Donation Program. Sales of the images benefit the Institute and donors are eligible for tax deductions equivalent to the fair market value of their photos. Landscapes, seascapes, animals, flowers – all may be accepted – whether new or vintage images. People may be included in the photo but only if unidentifiable (i.e., blurred figures at a distance).
Did you know that unused patents and copyrights can be donated to charity? Intellectual Property (IP) just sitting on a shelf will lose value as it becomes obsolete. The High Alert Institute IP Donation Program seeks to rescue stranded, technology-related IP with the potential for development into marketable products. Once accepted by the program, the owner/inventor is eligible for a tax deduction equivalent to the fair market value of the IP. The Institute receives the patent licensing fees or revenue from the sale of the IP to businesses, helping us to fund our mission. In turn, businesses are able to advance their markets and create jobs for less money than starting a project from scratch.
Disasters are defined as situations in which needs exceed or overwhelm available resources. Some disasters affect an entire community, while other disasters impact individuals and families. Crises of physical or psychological health can be very personal disasters.
The therapeutic value of pets during illness, trauma, and recovery is well established. And Koi fish may be well suited for people who are not able to provide verbal pet commands or physically care for pets like dogs and cats. Koi ponds are also a source of beauty and peace, providing an ideal setting for quiet reflection or meditation.
We are working to partner with pond installers and aquatic pet rescues/shelters to offer free or reduced-cost ponds with rehomed Koi fish to people seeking this type of pet therapy.
Disasters disrupt life and impact our sense of personal, family, and community safety. Survivors and responders alike often are not aware of the emotional, psychological or spiritual challenges that they may face from disaster onset through recovery. With two decades of experience training responders and communities to prepare for the behavioral health aspects of disasters, we will continue to provide education and a curated list of resources to groups or individuals.
Non-medical factors that impact overall health are termed Social Determinants of Health or SDoH. Noise pollution, poor air quality, and poor water quality are three environmental factors known to have a strong link to overall health. And the same environmental factors that impact humans impact their pets and other animals in their care. We continue to assist in advocacy, education, and technology development to mitigate the impact of SDoH on humans and animals alike.
Our efforts in shelter and rescue are the main focus of our environmental stewardship, reducing the environmental impact of non-native aquatic animals being dumped into public waterways. The High Alert Institute also assists innovators with the design, development, and evaluation of green and renewable energy technologies. Reducing the carbon footprint associated with disaster preparedness, response, and recovery furthers our continued mission to mitigate risk and improve resilience.
We partner with public and private organizations, sharing resources and fostering partnerships to improve disaster preparedness, response, and recovery, and mitigation.
The High Alert Institute team has over a century of combined research experience in medical, nursing, behavioral health, and disaster sciences. Our team provides support to researchers and technology developers through comprehensive literature searches and reviews, as well as failure mode database searches and adjudicated reviews.
When disaster strikes, most aquatic pet owners have limited options to secure the safety of their pets. Sheltering in place may not be possible if there is no power to provide aeration and “pet-friendly” shelters do not include ponds or aquariums. Our goal is to provide an option for aquatic pet owners in need of rescue and shelter for their finned friends.
Our goal is to share our two decades of disaster readiness experience with animal welfare organizations, shelters, caretakers, and pet owners, as they implement contingency plans for natural and manmade disasters.
