Science Denial Also Seen in Health Care

Science denial is a popular topic right now. It is convenient to punish some who deny some scientific findings while preserving the right to disagree with science in other areas. Sadly there is science denial rampant in health care. Many treatments have no evidence basis, others are significant but not relevant, but mostly there is ever higher cost for little gain in outcomes. New innovations have been some of the worst distractions because the evidence basis is ignored.

In the name of better health, our designers are shaping worse health outcomes.

It is difficult to tell which is worse - Science Denial that profits Big Business or Science Denial that profits Health Care Business. Science denial works for higher profits for both. 
  • Business Profit Focus destroys the external environment that shapes future human health largely by impacting environments negatively.
  • Health Care Profit Focus destroys the internal human environments and interactions between people and their environment that shape today's health outcomes.
Rachel Carson did a great job bringing our attention to bear on the external environment. Climate and environment deniers are are problem. But we also have internal environment problems that kill, maim, limit, and compromise Americans right now. Health care design helps create disparities that compromise health outcomes.

If science is the true focus,  it is hypocrisy not to address the determinants of health that already shape today's outcomes.

Political and Corporate Swamps to Drain, And Also in Health Care

We are more aware with regard to the countless corporations and their lawyers, accountants, engineers, and other designers that want more of our attention - and our dollars.

We are less aware of the past century of steady focus across health care by associations, corporations, institutions, management consultants, administrative/management, and others that have concentrated more health care dollars in ways less important for people and more important for those receiving the dollars.

Health care has become polluted by waste, fraud, abuse, administration, and measurement distractions. These were added to the procedural technical subspecialization priorities rewarded by payment designs - designs shaped by those who benefit most from highest payments.

More Costs Added from Medical Error Focus to Pay for Performance, But Nothing Compared to What a Precision Medicine Focus Would Cost

Medical error studies failed to control for the people, community, and resource factors that shape outcomes - resulting in a great pursuit of medical error for little improvement in outcomes. This also accelerated administrative and non-delivery costs while distracting team members from care delivery.

Pay for performance and related schemes such as Value Based, Readmissions Penalties, and MACRA fail for outcomes improvements as noted in this important review: “In summary, we found low-strength, contradictory evidence that P4P programs could improve processes of care, but we found no clearevidence to suggest that they improve patient outcomes.” from The Effects of Pay-for-Performance Programs on Health,Health Care Use, and Processes of Care: A Systematic Review, Annals of Internal Medicine 1/10/17.  

Even as one direction is cut off, new directions appear as in Precision Medicine for even more cost benefiting fewer and redirecting dollars away from most Americans.

Team Members Marginalized By Design

Even worse the rapid cost increases have force the Era of Cost Cutting since 1980. These cuts have been accompanied by more dollars diverted to non-delivery cost areas. The result is clear. These efforts have marginalized the team members that deliver care, especially across communities where most Americans are falling further behind in the basics - including basic health access.

Many Most Important Questions Are Asked But Not Answered

Why do we support and promote a culture of health care 
that insists that clinical interventions shape health outcomes?

Why ignore the evidence of little gain from clinical interventions
with maximal gain from personal, local, and community investments?

The science supports health care outcomes as 60 - 70% shaped by the personal, local, community culture of health. Not surprisingly these are the same factors that shape education, economic, and other outcomes that also contribute to better health outcomes in numerous and interacting ways. 
The addition of two trillion more dollars to health care costs over 20 years has steadily eroded the local, personal, community investments in a culture of health as seen across state and federal domestic discretionary budgets. This is far beyond social determinants as so many local environments, situations, conditions, behaviors, resources, and relationships are involved.

Addressing Disparities Rather than Discussing Disparities

We have learned to despise disparities or blame disparities on people, but ignore the designs contribute so much to the creation and maintenance of disparities.

Disparities are created by health care design with so much cost for so little improvement for so few people with dollars concentrated in so few places. Education dollars also shape disparities.

Health care has indeed become a virus, consuming all available resources - including what actually shapes health outcomes. Health and education have had more parasites added in recent decades - resulting in much higher cost and stealing the resources needed to actually deliver health care or educate.

Sent to Health Affairs Blog regarding MACRA Reform - Why Reform What is Not Evidence Based?

While Americans including leaders in health care are demonstrating for science and for evidence basis, it is quite interesting that we have continued support from health leaders for areas that lack evidence basis regarding significant outcomes improvements:

1. Pay for Performance
2. Value Based
3. Readmissions Penalties

These are evidence based for minor process improvements and also discrimination against providers where patient situations, conditions, and environments dictate lesser outcomes. These tend to be the providers serving where few remain. Even worse, lower payments and declines in payments are more likely to result in greater disparities. This was known by CMS before the 2010 reforms and before the implementation of MACRA. Even the RAND Consultant expressed misgivings as did MedPAC. But the innovation bandwagon has continued to roll on - and over the team members squeezed most between stagnant payments and rapidly increasing costs of delivery not related to the delivery team members.

Readmissions Penalties Fail to Indicate Quality or Predict Outcomes

Cherry-picking may have become so common in health care that it is difficult to see beyond the log in one's own eye. From DRGs to Medical Error to ACA to MACRA, belief has often triumphed over science or reasonable scientific exploration prior to implementation.

The one constant in health care may well be those less organized and most behind continue to be pushed behind to a greater degree - by those who make the designs. This could be omission from lack of awareness, the tragic result of "a higher result" not demonstrated, or deliberate omission for the purpose of concentrating health care dollars where they are already most concentrated.

Just In - Readmissions Penalties Fail to Indicate Quality or Predict Outcomes

Pay for Performance has failed to deliver on promised outcomes, has driven up the cost of delivery, has added distractions for team members, has distorted health services research, and has contributed to two forms of discrimination with regard to most needed providers. It is time for something else such as returning the focus to support for the team members that deliver the care.

Is Lean Primary Care the Next Bandwagon? - Americans continue to exhaust all possibilities other than the right solution.

The Primary Care Finances Fight Is THE Fight For Vulnerable Populations - What would actually address lack of access for vulnerable populations is a better financial design involving more dollars flowing to and staying in primary care, mental health, and other basic practice settings - ideally these would be specific to the team members that deliver the care.

The Least Healthy Counties Across the United States - It is not possible to address outcomes improvements without addressing the local, community, personal determinants of health. 

Two Forces Shaping Declines in Outcomes in Health Education and More - Health care is eating up the dollars that could be invested in people and better outcomes. Austerity focus is diverting the dollars that could be invested in people and better outcomes.


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