Monday, January 30, 2012

Pilot Programs—A Waste of Tax Dollars

Vindicated ! I have always been of the opinion that ‘pilot studies’ are a good waste of the taxpayers money. HHS and CMS seem addicted to these studies. It is almost like sending a program ‘out to bid’. John Goodman just seconded my motion of three years ago, and I do not belong to any Foundation ‘study groups’. I thank John Goodman for doing the hard hands on work to prove my hypothesis. The CMS Demonstration Projects are a good example of pilot programs

Most of these pilot programs are modeled after other ‘exceptional program’ already in progress. The selection criteria is the cost of Medicare services in specific regions of the country and an attempt to duplicate practices in each of these regions. Keep in mind this is a report from the CBO (Congressional budget office) which is only one measure of success or failure of a project. Nothing is said about quality of outcomes, return on investment of new paradigms of bundled payment, readmission to hospitals, morbidity or mortality reports.  It is a report from an agency totally separate from HHS or     CMS.

Successful innovations are produced by entrepreneurs, challenging conventional thinking — not by bureaucrats trying to implement conventional thinking.

On the supply side, we have the islands of excellence (Mayo, Intermountain Healthcare, Cleveland Clinic, etc.). On the demand side, we have a whole slew of experiments with pay-for-performance and other pilot programs designed to see whether demand-side reforms can provoke supply-side behavioral improvements. And never the twain shall meet

Can you think of any other market where the buyers of a product are trying to tell the sellers how to efficiently produce it?

Well put John Goodman. You have articulated well my meager general common sense approach and decades long observations of clinical practice.

Once again, ‘boots on the ground’ can quickly size up a problem.

Read John Goodman’s article on the Health Care Blog

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