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nereomata · 5 years

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MozCon 2019: The Initial Agenda

Posted by cheryldraper

We’ve got three months and some change before MozCon 2019 splashes onto the scene (can you believe it?!) Today, we’re excited to give you a sneak preview of the first batch of 19 incredible speakers to take the stage this year.

With a healthy mix of fresh faces joining us for the first time and fan favorites making a return appearance, our speaker lineup this year is bound to make waves. While a few details are still being pulled together, topics range from technical SEO, content marketing, and local search to link building, machine learning, and way more — all with an emphasis on practitioners sharing tactical advice and real-world stories of how they’ve moved the needle (and how you can, too.)

Still need to snag your ticket for this sea of actionable talks? We've got you covered:

The Speakers

Take a gander at who you'll see on stage this year, along with some of the topics we've already worked out:

Sarah Bird

CEO — Moz

Welcome to MozCon 2019 + the State of the Industry

Our vivacious CEO will be kicking things off early on the first day of MozCon with a warm welcome, laying out all the pertinent details of the conference, and getting us in the right mindset for three days of learning with a dive into the State of the Industry.

Casie Gillette

Senior Director, Digital Marketing — KoMarketing

Making Memories: Creating Content People Remember

We know that only 20% of people remember what they read, but 80% remember what they saw. How do you create something people actually remember? You have to think beyond words and consider factors like images, colors, movement, location, and more. In this talk, Casie will dissect what brands are currently doing to capture attention and how everyone, regardless of budget or resources, can create the kind of content their audience will actually remember.

Ruth Burr Reedy

Director of Strategy — UpBuild

Human > Machine > Human: Understanding Human-Readable Quality Signals and Their Machine-Readable Equivalents

The push and pull of making decisions for searchers versus search engines is an ever-present SEO conundrum. How do you tackle industry changes through the lens of whether something is good for humans or for machines? Ruth will take us through human-readable quality signals and their machine-readable equivalents and how to make SEO decisions accordingly, as well as how to communicate change to clients and bosses.

Wil Reynolds

Founder & Director of Digital Strategy — Seer Interactive

Topic: TBD

A perennial favorite on the MozCon stage, we’re excited to share more details about Wil’s 2019 talk as soon as we can!

Dana DiTomaso

President & Partner — Kick Point

Improved Reporting & Analytics within Google Tools

Covering the intersections between some of our favorite free tools — Google Data Studio, Google Analytics, and Google Tag Manager— Dana will be deep-diving into how to improve your reporting and analytics, even providing downloadable Data Studio templates along the way.

Paul Shapiro

Senior Partner, Head of SEO — Catalyst, a GroupM and WPP Agency

Redefining Technical SEO

It’s time to throw the traditional definition of technical SEO out the window. Why? Because technical SEO is much, much bigger than just crawling, indexing, and rendering. Technical SEO is applicable to all areas of SEO, including content development and other creative functions. In this session, you’ll learn how to integrate technical SEO into all aspects of your SEO program.

Shannon McGuirk

Head of PR & Content — Aira Digital

How to Supercharge Link Building with a Digital PR Newsroom

Everyone who’s ever tried their hand at link building knows how much effort it demands. If only there was a way to keep a steady stream of quality links coming in the door for clients, right? In this talk, Shannon will share how to set up a "digital PR newsroom" in-house or agency-side that supports and grows your link building efforts. Get your note-taking hand ready, because she’s going to outline her process and provide a replicable tutorial for how to make it happen.

Russ Jones

Marketing Scientist — Moz

Topic: TBD

Russ is planning to wow us with a talk he’s been waiting years to give — we’re still hashing out the details and can’t wait to share what you can expect!

Dr. Pete Meyers

Marketing Scientist — Moz

How Many Words is a Question Worth?

Traditional keyword research is poorly suited to Google's quest for answers. One question might represent thousands of keyword variants, so how do we find the best questions, craft content around them, and evaluate success? Dr. Pete dives into three case studies to answer these questions.

Cindy Krum

CEO — MobileMoxie

Fraggles, Mobile-First Indexing, & the SERP of the Future

Before you ask: no, this isn’t Fraggle Rock, MozCon edition! Cindy will cover the myriad ways mobile-first indexing is changing the SERPs, including progressive web apps, entity-first indexing, and how "fraggles" are indexed in the Knowledge Graph and what it all means for the future of mobile SERPs.

Ross Simmonds

Digital Strategist — Foundation Marketing

Keyword's Aren't Enough: How to Uncover Content Ideas Worth Chasing

Many marketers focus solely on keyword research when crafting their content, but it just isn't enough these days if you want to gain a competitive edge. Ross will share a framework for uncovering content ideas leveraged from forums, communities, niche sites, good old-fashioned SERP analysis, and more, tools and techniques to help along the way, and exclusive research surrounding the data that backs this up.

Britney Muller

Senior SEO Scientist — Moz

Topic: TBD

Last year, Britney rocked our socks off with her presentation on machine learning and SEO. We’re still ironing out the specifics of her 2019 talk, but suffice to say it might be smart to double-up on socks.

Mary Bowling

Co-Founder — Ignitor Digital

Brand Is King: How to Rule in the New Era of Local Search

Get ready for a healthy dose of all things local with this talk! Mary will deep-dive into how the Google Local algorithm has matured in 2019 and how marketers need to mature with it; how the major elements of the algo (relevance, prominence, and proximity) influence local rankings and how they affect each other; how local results are query dependent; how to feed business info into the Knowledge Graph; and how brand is now "king" in Local Search.

Darren Shaw

Founder — Whitespark

From Zero to Local Ranking Hero

From zero web presence to ranking hyper-locally, Darren will take us along on the 8-month-long journey of a business growing its digital footprint and analyzing what worked (and didn’t) along the way. How well will they rank from a GMB listing alone? What about when citations were added, and later indexed? Did having a keyword in the business name help or harm, and what changes when they earn a few good links? Buckle up for this wild ride as we discover exactly what impact different strategies have on local rankings.

Andy Crestodina

Co-Founder / Chief Marketing Officer — Orbit Media

What’s the Most Effective Content Strategy?

There’s so much advice out there on how to craft a content strategy that it can feel scattered and overwhelming. In his talk, Andy will cover exactly which tactics are the most effective and pull together a cohesive story on just what details make for an effective and truly great content strategy.

Luke Carthy

Digital Lead — Excel Networking

Killer CRO and UX Wins Using an SEO Crawler

CRO, UX, and an SEO crawler? You read that right! Luke will share actionable tips on how to identify revenue wins and impactful low-hanging fruit to increase conversions and improve UX with the help of a site crawler typically used for SEO, as well as a generous helping of data points from case studies and real-world examples.

Joy Hawkins

Owner — Sterling Sky Inc.

Factors that Affect the Local Algorithm that Don't Impact Organic

Google’s local algorithm is a horse of a different color when compared with the organic algo most SEOs are familiar with. Joy will share results from a SterlingSky study on how proximity varies greatly when comparing local and organic results, how reviews impact ranking (complete with data points from testing), how spam is running wild (and how it negatively impacts real businesses), and more.

Heather Physioc

Group Director of Discoverability — VMLY&R

Mastering Branded Search

Doing branded search right is complicated. “Branded search” isn't just when people search for your client’s brand name — instead, think brand, category, people, conversation around the brand, PR narrative, brand entities/assets, and so on. Heather will bring the unique twists and perspectives that come from her enterprise and agency experience working on some of the biggest brands in the world, providing different avenues to go down when it comes to keyword research and optimization.

See you at MozCon?

We hope you’re as jazzed as we are for July 15th–17th to hurry up and get here. And again, if you haven’t grabbed your ticket yet, we’ve got your back:

Grab your MozCon ticket now!

Has speaking at MozCon been on your SEO conference bucket list? If so, stay tuned — we’ll be starting our community speaker pitch process soon, so keep an eye on the blog in the coming weeks!

Sign up for The Moz Top 10, a semimonthly mailer updating you on the top ten hottest pieces of SEO news, tips, and rad links uncovered by the Moz team. Think of it as your exclusive digest of stuff you don't have time to hunt down but want to read!

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kristinsimmons · 5 years

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Commissioning Healthcare Policy: Hospital Readmission and Its Price Tag

By ANISH KOKA MD

The message comes in over the office slack line at 1:05 pm. There are four patients in rooms, one new, 3 patients in the waiting room. Really, not an ideal time to deal with this particular message.

“Kathy the home care nurse for Mrs. C called and said her weight yesterday was 185, today it is 194, she has +4 pitting edema, heart rate 120, BP 140/70 standing, 120/64 sitting”

I know Mrs. C well. She has severe COPD from smoking for 45 of the last 55 years. Every breath looks like an effort because it is. The worst part of it all is that Mrs. C just returned home from the hospital just days ago.

The youngest of six children, Mrs. C was born with many embedded disadvantages. Being born black in a poor West Philadelphia neighborhood in the 1960s is a story that too often writes itself with a bad ending. But Mrs. C avoided the usual pitfalls that derail young women in the neighborhood early. No drugs. No alcohol. No teenage pregnancies. Finished high school. Mrs. C. worked for the hospital as a unit clerk, had her own place, health benefits, and even a retirement plan.

Certain life habits, however, carry a heavy price. George Burns, the comedian never pictured without a cigar who died past his hundredth birthday, may have been immune to the effects of tobacco. Mrs. C was not. She started smoking when she was 16. She doesn’t recall why. Her dad smoking didn’t help perhaps. Nausea racked her body after that first drag. It eased up after. Too bad.

That measly cigarette became the great addiction of her life. Day by day, the exquisitely thin membranes of the lungs that mediate gas exchange were destroyed. By the time the disease manifests with shortness of breath and bluish tinged lips, it’s too late. Short of the very few who qualify for a lung transplant, the efforts of doctors at this point are for mitigation rather than cure.

Complicating things further, in Mrs. C’s case, the normally low pressure vascular circuit of her lungs became a high pressure circuit that places ever increasing demands on the normally thin-muscled right ventricle of the heart. This jeopardizes the ability of her heart to handle changes in blood volume.

A little extra fluid and the right side of the heart ends up causing unbearable swelling in her legs. A little dehydration and severe disabling dizziness on standing ensues. Adding to that that her tenuous lung function decompensates with the slightest respiratory infection, that chronic steroid treatment to decrease her wheezing suppresses her immune system, and that the young man down the street helpfully drops off Newports at her home for a few extra dollars, and it’s easy to see why the hospital is her second home.

The most recent admission to the hospital was for kidney failure related to taking too much fluid off with diuretics. What was to be a short stay for gentle hydration turned into a longer stay when a pneumonia complicated the matters (though a trip to the intensive care unit and a ventilator was barely but fortunately avoided). She was treated by the pulmonology team and sent home on a lower dose of diuretics.

The situation I am now confronting puts me in a quandary. Her edema and weight are up markedly just a few days after returning home. Could her fluid overload be because her kidneys are shutting down? Or does she just need more aggressive diuresis?

Should I guess? Knowing her present renal function would be helpful. But even if the Theranos lab I could appeal to for help wasn’t fictional, I would have to get her to my office everyday or every other day while adjusting her diuretic dose.

And so it comes to be that, days removed from a hospital admission, I’m sending her back to the hospital to be readmitted. According to some, this is not supposed to happen.

A policy on readmission

In 2008, the commission that advises Medicare – the Medicare Payment Advisory Commission (MEDPAC), issued a report that focused on hospital readmissions.

The focus on hospital readmissions had been of great interest to the health policy community for some time. At the core of this interest lies the belief that hospitals and physicians are incentivized to treat patients rather than prevent admissions.

The MEDPAC report wanted to discourage readmissions like Mrs. C’s. And so it wasn’t a terrible surprise that, rolled into the 2010 Affordable Care Act, was a section called the Hospital Readmission Reduction Program (HRRP) which created a system for Medicare to penalize hospitals with ‘high’ readmission rates. The program was rolled out in 2013.

At first, the program seemed to work like a charm. Hospitals significantly ramped up their efforts at care coordination. Teams of nurses and aids were assembled to make sure patients would get their medications as prescribed upon discharge and to check on patients once they got home.

Hospital readmission rates suddenly dropped and Medicare started saving money. A staggering 81% of all hospitals suffered penalties in 2018, which translates to ~$500 million or 0.3% of total Medicare payments to hospitals.

A complex analysis

But there’s more to this too good to be true story.

The HRRP penalty schemes are risk-adjusted based on administrative claims data. Risk-adjustment is a statistical procedure to take into account the diversity in complexity and severity of disease among patients so they can be compared.

Physicians know that risk-adjusted claims data are of dubious value because they themselves are often the reluctant data entry clerk in the byzantine scheme that starts with adding diagnostic items to the medical chart and ends with generating a coded billing claim for Medicare. Needless to say, there’s a huge potential disconnect between what a claim attempts to convey and the actual condition of a given patient.

Yet another major problem is that the risk-adjustment employed by the HRRP does not take socioeconomic status into account, when that is arguably the single biggest driver of poor outcomes and of hospital readmissions. The creators of the HRRP program seem to believe that a hospital located in poor area shouldn’t get a break for having high readmission rates, perhaps because they believe that hospital systems in general should be mindful of health inequities and address “care gaps” (differences in care provided to poor vs. affluent patients) in their neighborhoods no matter what.

Finally, the initial out of the gate benchmark for readmission rates on which the HRRP would adjudicate the need for a penalty was a national average. In such a scheme, a Johns Hopkins Hospital serving inner city Baltimore could be pitted against a regional hospital in rural Montana with an entirely different patient demographics. This made the regional hospital in Montana very happy.

Gaming the metrics

Regardless of these technical considerations, it is an adage of social science that any metric will be gamed, and healthcare is unfortunately not immune to that law.

One tool increasingly used by hospitals to comply with Medicare payments rules is to admit patients to short stay units, under so-called “observation status.” Another is to put pressure on emergency departments to avoid readmitting certain types of patients.

So, instead of primarily functioning as a triage operation where sick patients would be turned over to the care of the cardiologist in the hospital, the ER has been increasingly housing and managing heart failure patients to save the hospital money.

But the ER physician or the hospitalist supervising the short stay unit and who just meet a patient in the setting of an acute illness are poorly equipped to know which heart failure patient to discharge after a diuretic dose and which to keep for advanced heart failure therapies.

Source: MedPAC’s June 2018 Report (http://bit.ly/2CXD0fJ)

Nowadays, the cardiologist is increasingly insulated from those decisions. I have personally experienced with alarming frequency instances where I learn only after the fact that a complex patient of mine has been treated for heart failure in the ED.

And my experience seems to be shared by many of my cardiology colleagues, especially among cardiologists who work in academic centers that are most affected by the policy. Luckily, some of them are also clinician-scientists that can do more than just whine to colleagues about the new policy. They can also study its outcomes.

What do the outcomes data show?

In a pivotal study, a group of cardiologists (Gupta et al.) saw that the drop in readmissions that followed the introduction of HRRP was unfortunately accompanied by a reversal in the decade long downward trend in heart failure mortality. This reversal suggested a serious potential harm from the policy.

But the possibility of harm was quickly challenged by another group of researchers led by one of the biggest names in health policy: Harlan Krumholz, a cardiologist who directs the influential Center for Outcomes Research and Evaluation at Yale University.

The Krumholz group analyzed millions of Medicare claims data from 2007 to 2016. They also found that mortality for heart failure patients increased, but concluded that no causal link between decreasing readmission and increased mortality could be established.

Krumholz at al. noted that mortality rates for heart failure started climbing before the HRRP program was announced and they noted no inflection point in mortality rates with the policy announcement in 2010. The evidence for their claim is highlighted in the table below:

As can be seen in the boxed row, Krumholz’ team concludes that the increasing mortality slope post-HRRP is no different from that pre-HRRP because the change did not reach statistical significance at the obligatory and arbitrary P<0.05 level. The actual P-value was 0.11 and the confidence interval for the positive increase in mortality slope of 0.006 is (-.002 to .015). Even poor students of epistemology would be loathe to conclude this result excludes a signal of harm. It seems entirely plausible that, with all the limitations of the data set in question, mortality may in fact have accelerated after the institution of the HRRP. Yet Krumholz insists that no signal of harm is to be considered.

But this did not stop another group of cardiologists (Wadhera et al.) from adding their contribution to the HRRP literature. Using the same data-set that the Krumholz group used — Medicare claims data — these researchers found once again that accelerating mortality coincided with the announcement of the HRRP. More troubling, they also demonstrated that mortality rose primarily among patients not readmitted to the hospital.

A messy science

Admittedly this whole business of analysis is incredibly messy, with a number of moving parts.

My brief summary doesn’t do justice to a variety of maneuvers taken by the various groups to account for many of the limitations inherent in this type of study. Two of the competing analyses (Krumholz, Wadhera) used Medicare claims data while the other (Gupta) used a more limited voluntary registry.

During the time period in question, there were also other policy changes such as the introduction of new hospital billing codes (MS-DRG) that sought to adjust hospital payment rates to patient complexity. Better patient coding meant higher reimbursement from Medicare. Armies of “documenters” were then employed by hospitals to capture more revenue.

This means that the claims data gathered by the researchers might look significantly different from one time period to the next even if the patients themselves were ostensibly the same. As the readmission rate is risk-adjusted, it is eminently plausible and likely that systematically upcoding patient risk could actually have been the primary driver of the drop in hospital readmission rate.

The other program playing a confounding role is the Recovery Audit Contractor (RAC) program begun in 2010 to reduce payments for inappropriate hospital admissions. Hospitals responded to denials for inpatient admissions by expanding ‘observation status’ stays. Which was the biggest driver for expanded observation stays? RAC or the HRRP? Once again an exact attribution is impossible.

Denying the obvious?

Despite the messiness of the data and the variety of analytic methods used, a consistent and uncontested observation remains: Heart failure mortality has increased in the last decade. The question being hotly contested is Why?

Oddly, Dr. Krumholz is steadfast in denying the possibility that the policy may have caused harm, even though the independent and contradictory conclusions from the other research groups at least raises a reasonable doubt. And Dr. Krumholz has been quick to cast shade on research that does not conform to his conclusion.

By tweet he appears to ask for a level of detail his own papers lack, and he questions the legitimacy of another group’s data-set, all the while resisting any calls to put the program on hold despite the paucity of evidence showing benefit, the signal for harm, and perhaps most importantly, the concern of clinicians who see a mechanism for harm.

Greatly admire @rwyeh and his group…appreciate his focus on readmission &public policy. For such high-profile article, really need more info about statistical weighting. Methods should be sufficient so others can reproduce results. Can’t do that here. Look forward to more info.

— Harlan Krumholz (@hmkyale) December 21, 2018

Can you account for why the registry you used had, on average, such a small number of patients per site. Did you determine how many patients coded with heart failure by CMS were in the Registry? Just curious about the selection. It may not explain your results…but is a question. https://t.co/WSvJAN8Jjd

— Harlan Krumholz (@hmkyale) June 2, 2018

Dr. Krumholz also places much weight on an independent analysis carried out by MEDPAC which concluded there was no link between policy and the uptick in mortality. This particular conclusion rests heavily on the assertion that heart failure patients in 2016 were much sicker than patients in 2010. Recall that this coincides with a period of more intensive coding over the same time frame, so it is impossible to say this with any confidence.

The MEDPAC conclusion also relies on an analysis that finds no correlation between hospital level readmission and mortality rates.

While technically true, that conclusion overlooks that a large number of hospitals exhibited reduced readmission rates and increased mortality. Perhaps MEDPAC feels that patients dying at low readmit/high mortality hospitals should be mollified by the knowledge that somewhere there’s a low-readmit/low mortality hospital to balance things out?

That Krumholz and MEDPAC display such certainty about the direction of the signal they observe, and take pains to discount other possibilities seems strange and suggests that pre-existing biases may be at work. What might those biases be?

Conflicts of interest: You get what you pay for

In a world where heads roll for undisclosed personal financial conflicts of interest, it is remarkable that the current dispute, while full of scintillating exchanges about “propensity weighting” and other arcane points of statistics, does not reference any other potential conflicts at work that might affect the conclusions being reached.

Medicare’s decision to start the HRRP program didn’t come in a vacuum. It was inspired by years of research from Dr. Krumholz himself, who suggested that preventing admissions should be a goal for any policy that would aim to move the system from one paying for “volume” to one paying for “value.”

As far back as 2003, Krumholz held the view that:

“Hospitals may not support programs that improve the quality of care delivered to heart failure patients because these programs lower readmission rates and empty beds, and therefore further diminish already-declining revenues.”

If Krumholz’s unfavorable and crudely simplistic view of the operations and motivations of hospitals (and of the still relatively independent physicians staffing those hospitals) informs his position on health policy, it stands to reason that serious blinders would prevent him from seeing any evidence of harm in a particular policy that promotes the same view.

But that’s not all. Krumholz’s group at Yale received grants from CMS under the auspices of the Measure and Instrument Development and Support (MIDS) program to study and produce the metrics and instruments needed to devise the readmission measures.

The MIDS program supports the “development and use of clinical quality measures which remains a critical healthcare priority and the tool of choice for improving quality of care at the national, community and facility levels” and it allocates $1.6 billion dollars to this purpose.

Thanks to a bipartisan act of Congress, a helpful little website, usaspending.gov, provides contract level detail about payments made to the Krumholz’s group from the MIDS program. Those payments can be seen in the table below:

The numbers are staggering. I know little about how to interpret these data about federal contracts, but it sure appears that the Yale-New Haven Health Service group led by Krumholz has received $144 million dollars since 2008.

Yet the only clue to these payments in Krumholz’ published analyses of the HRRP program comes in one disclosure sentence in a footnote, as seen here:

It seems to me that the disclosure is hardly proportional to the amount of funding that his group receives and understates the inherent pressures it must be under to demonstrate that the policy did not actually result in higher mortality.

And recall that MEDPAC’s “independent” analysis that also rejected a policy-mortality link came from the organization that recommended the policy to begin with. The bottom line is this: There’s a tremendous amount of face to lose and a massive source of institutional funding at risk if the policy is found to be harmful.

It now becomes more clear why, in the following tweets, Dr. Krumholz feels that only he can say anything definitive about readmission rates and mortality:

Um, @JAMA_current, even the authors say they cannot say their findings are causal… "but whether this finding is a result of the policy requires further research.” Why do you promote the paper as proving harm? Need to treat twitter like you do any of your Editorial comments. pic.twitter.com/xugasHvPWY

— Harlan Krumholz (@hmkyale) December 26, 2018

6/Hospitals that have improved their readmission rates tended to improve their mortality rates. Published in @JAMA_current… https://t.co/R7FXLwTMPp

— Harlan Krumholz (@hmkyale) December 22, 2018

A diversity of biases

Biases are ubiquitous. When I was a cardiologist-in-training, spending hours on the hospital consult service for a fixed salary, I vividly recall looking for ways to avoid doing any work I considered unimportant or banal: The minor cardiac enzyme leak in a patient with a widespread infection; The extra heartbeats on the ECG that the ER physician didn’t like the look of; etc. “Are you sure you need an official consult?” “The chances we’re going to recommend doing anything about a small enzyme leak in an 80-year-old with a severe lung infection are very low… “ I was even successful sometimes.

Contrast these comments to my demeanor in private practice where I am acutely aware that my income relies on such consults: “I just need the patients name or room number…” “I’ll take care of it!…” “I can put in the orders if you’d like!”

But there are other biases and incentives that motivate human beings, apart from personal financial incentives. Do they pale relative to the financial ones as is so often claimed? How does one begin to quantify them?

When it comes to the HRRP policy, no individual person’s bank account ballooned every time a patient didn’t get admitted. And yet this is a story of ideological bias that drove the design of policy and now claims ‘success’ for its own program. The HRRP saga is illustrative of the importance of non-financial bias and of the dangers of blinding ourselves to that bias.

The story also highlights the downsides of tweaking healthcare systems that were built to deliver more care.

Clearly, I personally have a direct financial conflict of interest to provide more care. Since I haven’t talked anyone out of a consult in 8 years, I’m probably guilty of participating in a system that detractors appropriately criticize for promoting overuse of healthcare.

But the problem is that some of those consults I was trying to avoid as a fellow ended up really needing a cardiologist. There was the 55-year-old Cambodian woman admitted to the medical intensive care unit with pneumonia who went into atrial fibrillation. I recall rolling my eyes and thinking that the ICU could certainly handle this without a cardiologist. It turned out she didn’t have a pneumonia. It was pulmonary edema from heart failure related to undiagnosed rheumatic mitral valve disease. She had been in the wrong unit. She needed diuresis, heart rate control, and eventual surgery to replace her valve, not antibiotics. Less isn’t always more.

Attempt to reduce inappropriate hospital admissions? Get ready to pay a price. To contradict Dr. Krumholz, it is entirely probable that we are underestimating the upside of our current system when we contemplate changing the status quo.

We are underestimating the downside of our current system when we contemplate change. We need to take some risks to do better. #abimf2013

— Harlan Krumholz (@hmkyale) August 5, 2013

Final Thoughts

Ironically, the HRRP quagmire offers a number of clarifying lessons.

Empiricism in social policy is a subjective enterprise. The often parroted conclusion is that cold, hard, unbiased evidence trumps the biased, unmeasurable judgment of clinicians. Yet, frequently, real world data-sets are complex, the choice of analytic paths can be highly variable, and the instruments to measure success are often imperfect. As it relates to HRRP, which analysis should we trust? The choice requires faith. And if the currency here is faith, perhaps the concern of clinicians at the bedside has more value than advertised.

Metrics won’t save us. The narrative of metrics is an appealing one that promises hard and objective accountability. The problem comes when the metric (readmission) becomes disconnected from outcomes that actually matter (death). False and blind prophets are good descriptors for those who claim to be unable to see without metrics. The fools in this enterprise are easy to identify as those who think the answers lie with ever better metrics.

Conflicts of interest: Going beyond the simple narrative. Focusing on biases induced by personal financial interests is a mistake. Personal enrichment is just one bias in a sea of conflicts. In the healthcare context, financial disclosures—while clarifying in themselves—may simply give cover to other, more perverse biases, unless those other biases are equally disclosed. It requires diligence to ascertain the impact, and direction of bias. Rarely do we get the opportunity to observe the direction of bias in policy research. In the case of the HRRP, the presence of bias was made evident because research groups with opposing biases (clinician-scientists versus policy wonks) have reached conclusions that would be expected on the basis of those pre-existing biases. How often is the problem of such bias examined in the design, implementation, and analysis of health policy?

Beware of technocrats with all the answers. I am reasonably sure that if practicing clinicians would have been asked to devise a rule to reduce heart failure readmissions for the whole population they would have refused. It seems too challenging a task to get right. Even if clinicians can be induced to participate in the design of such a policy, most would readily acknowledge the likelihood that it could harm some patients. It requires a special type of hubris to design a policy and refuse to acknowledge its potential for harm. Unfortunately, hubris within a public health community that believes only they can give us a better health system is more feature than bug.

As for Mrs. C, she has been home for 16 days. All fingers on both hands are currently crossed.

Anish Koka is a cardiologist in private practice in Philadelphia. He can be followed on Twitter @anish_koka. This post originally appeared here on The Accad & Koka Report.

Commissioning Healthcare Policy: Hospital Readmission and Its Price Tag published first on https://wittooth.tumblr.com/

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gocasualrunawaycollection-blog · 6 years

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I can't afford insurance in Ontario. The basic rates for males under 25 are the highest in all of north america. I was thinking of changing my legal address to Manitoba to apply for their insurance whilst forwarding all my mail to my actual address. I can't take public transit, I live and study in the suburbs. I'd also have to bike 20kms each way to work otherwise. I was quoted between 6000-8000$ /year despite no accidents,tickets and choosing a relatively cheap car to insure.""

I want a car but my parents wont pay for insurance?

I asked this question before, but people were being extremely rude so I deleted it. If I get a car, I will be paying for everything myself. The car, the gas, the maintenance, etc. The only thing that I will not be able to afford is the insurance. I don't really care about having my own car, but I can't drive my parents' cars: my mom's is for her work, and my dad's is really expensive and he doesn't want me driving it. Either way, just to drive someone else's car I have to have insurance to cover myself and any damages I could cause in case of anything. So, anyways, the only thing I need my parents to pay for is the insurance. They absoulutley refuse. They think that I don't need to drive. I don't want to depend on my friends to drive me everywhere. They can definitely afford insurance, they just don't want to pay for it. I might sound spoiled or whatever but I'm not. Ever since I could remember, I've had to pay for most of everything I own. All of my clothes, toys (when I played with them), iPods, the computer that I'm on right now. I'm paying for my text messaging, too. so, I understand the value of money. I just want them to pay for this one thing. so, my plan was to buy a car, and then threaten to drive uninsured until they get insurance. Kind of mean, I know, but I'md esperate. What do you think?""

Who is the best for motorcycle insurance?

Roughly how much would the insurance cost on an Audi A3 1.4 cost at 17?

Why we need car insurance ?

I'm 20 and my car is 2010 Nissan Altima, my insurance company told me to pay 190 every month, I agreed but later I found the are asking for 220 then 250 for no reason and no ticktes so I cancled my insurance with them and now I'm driving for tow years without insurance and save $6000 from the car insurance,, I never pulled over by police never have one scratch on my car even I traveled to NY and LA more than 4 times ! Why I need car insurance? You do think the person should have the right to choose if he need insurance or not ?""

Where to find a dental insurance/plan that provides full coverage(if not 100% something close)?

I am sick and tired of being robbed over and over by those dental offices...whatever my dental plan says it saves on me they always come up with something to make me pay as I am not insured at all! I am willing to pay more for and expensive dental plan/insurance that covers me 100% or very close from that(=> 80%) I just don't want to go through the price of each service I get from the dental office because its useless! ... and please don't post me links to those websites that collects my private information just to give me quotes! Only if you tried the insurance or know somebody tried it...I am looking for life experience not google search results! thank you very much :)

Why should I compare home owners insurance companies?

We have owned our home for 13 years, and we have always just stuck with the same insurance provider we had when we first got our mortgage. I am not sure if the premium we are paying is fair or not. I have no idea what the rate would be to insure our home with some other insurance company. Is it really worth the time and effort to compare home owners insurance companies to see if we can get a better rate? How much lower could the premiums actually be, and could we really end up saving that much money in the long run?""

Cheap car insurance companies in the UK for young males?

Health Insurance in NC?

Recommendations for Health Insurance in NC for adult and Child. Any good experiences with service and cost?

How much would it cost for a 17 year old to insure a.....?

How much would it cost for a 17 year old to insure a 2007 VAUXHALL CORSA VXR TURBO 1,598 cc""

Does any one know where to get cheap insurance 4 low mileage use under 4000 miles a year?

Why are so many Americans against affordable health care?

How much will my speeding ticket be?im 57 never once had a ticket/moving violation..it was in a school zone?

i was caught going 20 on a 15. i was driving my friends car will her insurance go up now?..i am on her insurance since we live togeather. does anyone know how much this ticket will cost me i am in las vegas

How do I shop for Medical Insurance?

I am finally getting dropped from my parents medical insurance in March. I will be turning 26, so its time to shop for my own medical insurance. I don't want to continue the coverage that my dad had me on, its way too expensive. I am a white male, 25, non-smoker, looking for a high deductible and tiny premiums. Just want to get my bases covered. So where do I go to get medical insurance? How do I know I am getting the right price? What should I look forward to paying? Can I get free medical insurance somewhere? Should I get dental and vision insurance too? Any help is greatly appreciated. Thanks.""

Auto insurance price? 16 year old.?

I am 16 in June. I own a mustang lx but it is the 2.3l model that my company geico doesn't classify dangerous or a sports car. My dad has wonderful credit. The car and insurance is in his name. So is my car ad tittle and tag. Basically to keep costs down everything is tech his. I will be listed as driving 10-15% of the time As a secondary driver. His driving record is clear and great credit. He has a jeep patriot 2013 and my 1989 lx mustang will be the 2nd car. They got a brand new car and his credit when checked was about the best possible. Forget the numbers but literally the best possible by a few. Never missed payments etc. so about how much a year or every 6 months would my 89 4 banger mustang cost to insure?

Car insurance ? Can my girlfriend be a policy holder on one car and named driver on another?

Can my girlfriend be a policy holder and main driver on her car and a named driver on mine? Will this affect her insurance in anyway?

Is Progressive a good auto Insurance provider?

I have used Geico for years. I have been extremely satisfied with their service. However, my premium is still more than I want to pay. I got a quote for Progressive and it is considerably less. Anyone out there have Progressive and satisfied with them? How have they handled claims in the past? Any other good, reasonably priced auto insurance companies?""

Will car towing service affect my future insurance quote?

I had my insurance company tow my car today(roadside assistance), will the towing service increase my future insurance quote? Thanks.""

In Michigan do you need to keep full coverage on your motorcycle even if it is in storage when you have loan?

You get your full coverage on the motorcycle when you purchase it but winter comes and you have the insurance company reduce it to storage insurance. Can you do that and if you can is the insurance company required to let the title holder know of the insurance coverage change?

What insurance companies will insure someone with a DUI on his record?

My boyfriend and I have our car and house insured under State Farm, but apparently they have a zero tolerance policy and have dropped him from the insurance. My agent was saying something about 're-evaluating' at some point in the future, but he was being so rude to me about it (I wasn't the offender) that I didn't really listen, and have no interest in staying with State Farm (at least with that agent). I assume if State Farm has a 'zero-tolerance policy,' they're not the only company that does, so what companies would insure us? We understand that we'll have to pay higher premiums, which is fine, since it's the consequence of his actions. I'd just rather not go with some cheesy insurance like The General or Safe Auto.""

How much does it cost to be added on to someones auto policy for a week?

I live abroad and will be in the US driving my dads car for 10 days. How much should it cost for him to add me on to his insurance for such a short period?

Car insurance rates in Ontario for new driver?

I plan to import my '01 Camry from USA to missisuaga. How much shd I expect to pay p.m. in car Insurance rates ? I have 3 yrs clean driving history in USA.Will my driving history in USA help with getting a better rate in canada ? Initially I will have only a US drivers license.Pls help shed light on my doubts ..

Will my insurance go up for a out of state speeding ticket? I have usaa insurance?

I was an hour away from my house in nebraska and my parents will kill me if they found out. I got a speeding ticket for going 73 in a 55 zone in iowa. I have USAA insurance. Will the rates go up? Will my parents find out?

Cheap Car Insurance for a 20 year old...?

I'm 20 years old I live in Houston, Tx 77045 I have a 2003 Toyota Corolla CE. I never had accidents, or traffice tickets. I need a insurance that will not be so high. Any suggestions? Thanks..

How much would car insurance cost for a 17 year old from allstate in california?

does it also matter what kind of a car it is? I have a 1999 chevy malibu

Geico car insurance !?

i have car insurance with Geico, on the policy was said Effective date : 12/20/2009 ... ( just bought insurance from Geico on 12/29/2009 ). i got accident today,( 12/22/2009 ),a deer jump into the front of my car and the front bumper messed up really bad... i know on the policy its said the effective date is 12/20/200/9 but still i wonder am i cover when i just recently bought the car insurance from them ( for 1 day and a half i guess ) ?!!! am just so ... panic and .. confuse right now !""

In Southern California where is the best place to get a perscription with out insurance?

I have Strep throat and need Medication!

Can you get cheaper car insurance when hiring from a car rental place?

What is no claims discount in car insurance?

""How much on average would insurance cost for my 150cc motorcycle? 23 years old, 100% clean driving record.?""

Live in michigan and if it makes any difference, i would be driving it under 20 miles per day.""

What auto insurance offices offer reduced cost auto insurance program in the San Fernando Valley?

Details below if you do not know which one I am referring to? I'm not talking about the cliche low cost auto insurance that is available to everyone. etc...I'm talking about a specific plan offered by the state of California available at some insurance offices for low income individuals. I found one office with it, it isn't close enough, does anyone know of any more offices ? The California Low Cost Automobile Insurance Program (LCA): The California Low Cost Automobile Insurance Pilot Program, created in 1999, established a low-cost automobile insurance policy for residents of Los Angeles County and the City and County of San Francisco. California Law requires that all drivers be insured. However, too many low-income drivers remain uninsured because the costs of standard auto insurance premiums are beyond their financial reach. The programs purpose is to provide low-cost automobile liability insurance to good drivers who demonstrate financial need.""

Can someone explain somethings about Car Insurance to me?

Okay, long story short. Last week I got in a car accident with some friends. My back is messed up and I went to the doctor Monday. He told me that my lower back muscles, tendons, and my lumbar are all swollen and sprained. My parents want my friend's family's insurance to pay for the doctor bills, plus they want to get me something (I think it's called compensation or something, I can't remember) basically, the insurance company will pay me money. I guess my questions are just these: If you were my friend's parents in this situation, would you be mad? Is my family technically suing my friend's family? Does her family find out about this or is it all confiential between me, my parents, and the insurance? We live in Washington state and got in an accident on the Interstate, heading down to Seattle for the afternoon, if it changes anything""

What exactly is a lapse in car insurance ?

What if I decided to ride my bike instead or what if I will be out of country for 2 months and want to save 200 Dollars and cancel the insurance? How do they define lapse ? I heard even when you don't own a car you will be considered to have a lapse in insurance and you pay more money even when you did not touch your car or didn't even have one.... that dosen't make any sense to me!

What type of insurance covers any driver who gets behind the wheeL?

and what is liability insurance and who does it cover?

How How to Get the Cheapest Motorcycle Insurance?

I have no health insurance for my 5 month old?

Ok so my 5 month old hasn't gotten we shots because I came back to NYC from CA due to my mother being sick but I don't planned to live here so I don't want to reopen a Medicaid case out here is there anywhere i could go or something i could do? Plz help

High Risk Auto Insurance - Where can I find the lowest quote online?

Is there any online auto insurance website that specializes in getting the lowest rates on car insurance for high risk drivers? If so can anyone guide me to one?

HEALTH INSURANCE PAYMENTS?

I went to the doctor. The cost was $164. My insurance was expected to pay $115. I paid $49. Later i found out that my insurance actually paid $131. I had no prior balance, what is the balance after my insurance payment was received?""

I need help with auto insurance?

first time purchasing auto insuranace in it say that i only have to make 6 payment of 177$ then that it. now does this mean i will have insurance free for life after that ? or what happens? also so im going with safe auto minimun insurance. thanks

""I'm moving to another state. How long do i have to get proof of insurance, new drivers license, etc?""

How long do i have to complete the entire process of getting new proof of car insurance, attaining a new drivers license, registering my vehicle, and getting new license plates? I have looked on the dmv website and i am more confused now then before checking the website. The website claims you have 60 days to get your new drivers license but, you have 30 days to have your vehicle registered. This cannot make any sense because in order to have your vehicle registered you must have a valid drivers license in that state (at least for the state i'm moving to). Can someone shed some light on this topic and how long on average an individual has to complete this entire process? thanks!""

What health insurance is best and affordable for my wife?

We had a baby 3 months ago, but I am looking for health insurance that is good and affordable for my wife. Any suggestions?""

Does insurance agents give you the lowest price insurance?

or do they give you a higher priced insurance to make more profit?

Car accident. how much will my deductable go up?

i might need a new bumper. i was stopped in a parking lot going into first gear when this lady backed into my bumper. she claimed fault for it and i have a signed statement from her. i am 16 years old and i live in the state of Ohio. perfect record and no pasted accidents. will this make my insurance go up? and if so by how much?

How does health insurance work??? Payment?

I'm 18, jobless. My parents will stop paying for my insurance soon. How do I get a new plan and what will the cost be? NO MEDICAID. also what if you're pregnant""

Health insurance plans?

I live in Florida and I'm a college student. I want to know what are good affordable insurance companies for college students or people in general. I prefer to know about those that are well known and have a long record history and not some sketchy insurance company. Thank you!

Health insurance question?

Is there any way I can get health insurance? I have no money and no job. I recently had to quit my recent job due to moving. I'm 19 years old and have a disc herniation that I'm trying to get checked out. Parents don't have money and will not take me not their fault, healthcare as I know is expensive. Ill have a job by the end of November is there anyway I could somehow get insurance through a loan or something similar? Probably a dumb question but it don't hurt to ask.""

What is a good cheap online insurance?

I have Allstate at the moment but I want to swith to something that is way cheaper but that is still good coverage any ideas? thanks. is there aperson i can go to that will help me find the cheapest insurance based on my information?

Can you transfer car insurance to someone else?

My mom bought me a car. She lives in Pennsylvania, I live in Michigan. She's going to buy insurance for the car in PA, in her name, so she can drive it here. Can I use her insurance or can it be transfered? I would rather it not be transfered just use her insurance.""

18 Yeasr old with 94 ford taurus wagon. cheapest insurance??

I'm 18 and just got a 94 ford turus wagon for my first car. where do you think i should get my insurance?

Cheap Car Insurance for a 20 year old...?

I'm 20 years old I live in Houston, Tx 77045 I have a 2003 Toyota Corolla CE. I never had accidents, or traffice tickets. I need a insurance that will not be so high. Any suggestions? Thanks..

Jeep Wrangler Sahara insurance?

I am a 16 year old female... I want a 2004 Jeep Wrangler 4x4 Sahara as my first car. My mom seems to think the insurance is too high. Can anyone tell me whether the insurance on it would be super high or give me an average number for insurance? Would it be cheaper on a smaller car? thanks .xx

Lowest insurance rates?

Hi!!! I would like your opinions on the lowest car insurance rates. I am currently with an insurance company that has not lowered my rate and I have been accident free for more than 5 years. So I am going to switch carriers and wanted to hear your opinions on where I should try.. Thanks in advance

Car released to my insurance company?

my car has been released to my insurance company, for them to ascertain whether my car is repairable or is a write off, the car an MGTF Convertible was burnt to dust at the week-end and no courtesy car has been provided, making my journey to Edinburgh from Glasgow and back again every workday a bit of a nightmare, has anyone any idea how long this process of making me an offer will take, as it is costing me a fortune in rail fares""

How much insurance cost would it cost for a provisional driver on a vauxal corsa?

hi, im 16 and soon to be 17 and learning to drive. i want to find out how much it would cost for me to be on a vauxal corsa (2001?)(1.3L) on a provisional learners license. i wanted to go on my mums tesco car insurance but they said i need to give them my provisional licence details but ive only recently sent off for one so i cant give them the details.. any ideas on the cost (any insurer) thankyou so much! katherine""

Would I be saving money if I bought a car and did the liability only insurance policy?

Right now, I am 17 years old and I have had my license since April 28th 2011. My family is on Allstate and their policy states that as long as I am driving a car which is not registered to my own name, I have to do full coverage (this is very expensive <$2000 since I am a new driver). If I buy a cheap car, one with a $1000 price tag, will I be saving money? Liability only insurance is cheaper, but by what amount? Is it worth driving a cheaper car?""

Cheapest liability insurance?

I'm 19yr old male in Texas w/ good-driving record, no tickets, have license for 2yrs now, have liability w/ State Farm for $116/mo looking for cheaper premium. W/ this info, can some one point me towards the direction for finding a much cheaper premium, preferably LESS than $100! Thanks.""

New driver trying to get insurance... Quote for 1750 in November... Why has it gone up to 4400 now?

Hello all, I'm 17 years old (male) and passed my test earlier this month. In November I just thought I'd get a rough figure for insuring a 1.2L Corsa (2001)... I got a quote from Quinn Direct for 1750 (I put in the details as if I had already passed etc). So yes, more than the car is worth, but my parents and grandparents were willing to help me out with it, and I was pleased. So, Christmas has been and I thought I'd get looking... I went back on to Quinn Direct and now for a 1L Corsa (2001)... The quote is 4450!! That is ridiculous! It's true, I'm a 17 year old male... Bla bla... But 4450 for a 1 Litre car? All my friends are with Quinn Direct, and their 1.3L Fiesta's etc are only 1900 to insure! Gocompare and all those don't give me much better quotes either. I've also done the Pass Plus. Can anyone shed some light on this please? Thanks!""

I am planning to buy medical insurance. Which insurance company provides affordable service with good service.

I am 25 working as a consultant but my company doesn't provide insurance. I am looking for a good insurance company to provide me with affordable service. Also what does term Plan type, Deductible, Coinsurance and Office visit mean in simple terms. I work in seattle.""

How to handle a partial month of health insurance?

I currently am paying for a family health insurance plan with Oxford. The premium is $800 a month, due on the first of the month for that month's coverage, with a grace period of about 30 days. I am switching from a contracting position (where I pay my own insurance) to an employment position (with a very nice health plan) on 9/7/10. What I want to avoid is paying $800 to my current insurance company when I only need 7 days worth of coverage. I also want to avoid a lapse in coverage. Do I not pay anything until the 7th, when my new insurance plan kicks in, and them call them and tell them I am cancelling and only want to pay from the 1st through 7th? Or do I pay the full $800 and hope I will get a pro-rated refund? Thanks in advance!""

Car insurance total loss?

I own a 1997 dodge intrepid std 4 dr sedan 6cyl gasoline 3.3 liter 4 speed in fair conditions cd player no rust with 197,242 miles. My car was was in a hail and tornado damage where the hood has a dent and the driver and passanger side have dent and the trunk. I have full coverage insurance and they telling me that my car was total last i love my car and i spent alot of money fixing it and it drives great no problem. So I was trying to get some help from some one that could tell me how much is my car worth so they wont give me less money and if they offer me less what could I do. I am not trying to bew greedy but i do love my car and spent alot of money on it. I would rather get it fix . PLEASEEEEEEEEEEEEEEE HELP ME""

Do I Need Insurance Before Buying A Used Car?

I'm a first time buyer. But I'm still not sure what I want to get. I mean how would I tell it to an insurance agent when I don't know what I'm getting yet. Heck I could find a car tomorrow, next week or who knows maybe a few more months. And what if I buy a car out of state? I live in Oregon, but I might see something I like in Washington? Do the dealers let me drive the car home? And if not, can I buy the car and let a family member who has coverage drive it home?""

Is it possible to get different car insurance under the same household?

Hi, So I have a question regarding different car insurance. MY family has allstate for the car insurance. However, I do not want to go under allstate for family reasons. I am trying to get geico for my car. However, my father states that if you were to get geico you would still have to add everyone's name under the insurance policy. I am trying to get my own individual policy without adding anyone under the car insurance policy. I wanted to know if it is possible to get different car insurance under the same household? Thanks :) P.S: I am 23 years old. About to turn 24 years old. I wanted to get my own individual policy without adding anyone on the car. The car was a gift from my parents to me.""

""I need help w/ having a DWI, sr22's and autoinsurance?""

so i got a DWI in march of 2010. I havent had my license in over a year as penalty. but now i need my license & insurance. I have no idea what to do, where to get sr22 or whatever it is, nothing. i live on my own and i dont know what to do at all. i have no help. i used to live in california. thats where i got my DWI. but im september, i moved to oregon & thats where im currently living.""

About how much does full coverage auto insurance cost?

I'm just curious of how much a good estimate is. If you need a vehicle, try 2000 Honda civic.""

Cheap car insurance 22yr old just passed test but have been banned for drink driving?

hi all i've been banned from driving and now i've passed my test i need cheap car insurance but everywhere i go is way to high for me. any advice please?

Will my car insurance monthly payments increase AFTER i rent a vehicle (READ BELOW)?

I already own a 4-door sedan, which I cover with monthly insurance for a reasonable value. Although recently, I had to rent a pick-up truck from Enterprise Rent-A-Car to move some furniture from a friend's house to my place. Upon sigining of the necessary rental documents, the rental car agent and I came across the section about insuring the rented vehicle; as Enterprise Rent-a-Car will always offer their own insurance services, I mentioned to them that I already have car insurance of my own, of which I can look forward to saving the additional $39 which Enterprise Rent-a-Car originally offers. I encouraged Enterprise Rent-a-Car to contact my insurance provider so that both of us can be sure that my car insurance provider will cover the pick-up truck I am about to borrow from them. (Full coverage that is) Everything went smoothly and Enterprise Rent-a-Car agreed to insure their truck under my own car insurance. My car insurance provider also approved of my intention to borrow the truck and cover the said truck using my insurance. Two weeks later came the insurance bill, and to my wondering, I saw that my following monthly insurance payments all jacked-up their prices to one dollar addtional per month! Huh?!?!?! What could have caused this? Could it be the fact that I have had the rented pick-up truck and the request to insure the said truck under my own car insurance resulting to a somewhat considerable claim of some sort? Any opinions or personal experience you may have had? Thanks Alot YaHoO Readers/Responders! A vote comes to the most sensible and brainstormed answer!""

What is the best student accident insurance?

What is the best student accident insurance plan for Kinder level in Pennsylvania?

What is to stop people from taking the fines instead of paying for insurance?

it seems like they are not much different then a high deductible insurance plan

Whats the cheapest auto insurance for an 18 year old male?

Got a job and kind of looking towards to putting my truck under my name but i was just wondering what the cheapest insurance would be.

Car Insurance. 50/50?

I was in a minor car accident like a month ago. and they've finally almost resolved the claim. It's probably going to be 50/50, now how will that work out in terms of money?? As in, I had an estimate of the cost it would have took to fix my damage, am I gonna get half of that?""

What would be my insurance cost if i got a 2010 Subaru RX STi in chicago?

any idea? like a year?

How much would insurance cost for a 16 Y/O Girl with a 1997 Nissan Maxima GLE?

I'm buying a Maxima and I'm turning 17 in February. I plan on getting the car on the road next month and I have a 10% discount from my driving school for taking drivers ed. How much would insurance cost (roughly) per month for a 16 year old girl with a 1997 Nissan Maxima GLE?

Where can a recent college grad find affordable short-term health insurance?

I am not sure what to do about health insurance after I graduate from college (in a few months). I know that I am going to need some time to job hunt (my field is very competitive) and I would also like to do some volunteer work before I start my career. Problem is, if I am not a full-time student, my parents' health insurance won't cover me, and if I don't or can't find a job with benefits right away, I will be left uninsured. Any ideas where I can get affordable health insurance for short-term (no more than a year and a half) ??? Thanks!""

How to see a doctor without health insurance?

im a student living in southern california. i havent seen a doctor in years because i cant afford health insurance, but recently ive noticed that i may have an issue that should be checked out by a doctor. how do i go about seeing one? what do i do? where should i go? any advice or tips would be very helpful. at this point i dont care how much debt i have to incur to do it, i just need to do it. thanks.""

I need to know some car insurance quotes if any one knows them?

Im 15 i have my temps and almost got my licence and im looking to buy a car and was looking at either a jeep of ford ranger under the year of 2000 any one know what insurance would be for me?

Cheap Car Insurance for a 20 year old...?

I'm 20 years old I live in Houston, Tx 77045 I have a 2003 Toyota Corolla CE. I never had accidents, or traffice tickets. I need a insurance that will not be so high. Any suggestions? Thanks..

Looking to get a car insurance but.....?

Looking to get a car insurance but i am not sure what it covers and what should i ask my insurer to include in my policy?

Is it possible to get insurance for a couple of months for 18 year old?

I passed my test a couple of months ago and really want to drive for summer, but I can't afford a car at the moment. Is it possible to get insurance on my mums car for a couple of months? as I go away to uni in September, possibly as a named driver? thanks.""

How much is Taxi Insurance in South Jersey?

I heard Taxi Insurance is Cheaper in South Jersey vs North Jersey. What town are you in? Thanks.

How do I deal with my car insurance company after a crash?

An elderly man stopped in the middle of the street with his car. I couldn't stop in time not to hit him. So we collided. Now my insurance company refuses to pay for storing the car while their adjustor and the other insurance adjuster come to look at the car. I think it is totalled, but not positive. My apartment building has an ordinance against putting crashed cars in the parking lot. I live in West Los Angeles, which is highly populated, and I will get a ticket if I leave it on the street. It is not driveable. The storage places here cost $100 per day. I don't know what to do. Is there a car storage facility in West Los Angeles that can charge me a small amount until the adjusters come to look at it?""

Can i find out someones car insurance company?

a lady hit my car back in march of this year. she agreed to pay for the damage but then moved out and skipped town. well the police finaly found her but the problem is i dont know her insurance company. i have her full name, and her vehicle vin number. i dont want to claim it on my insurance so my rates go up, thats nuts. so i need to find her insurance company so i can file it with hers! anyway i can do this?""

Whats the best way to cancel my car insurance?

Iv had my car insured fully come with Halifax since the 28th Dec and iv already paid around 450 on the policy but as they will not give me any sort of discount on to add my new car on the policy I want to cancel it but they want me to pay another 300 to cancel it, its only been insured for a month and I agreed to pay 1600 per year and they want nearly half of it, would it affect future insurance if I just cancelled it anyway?""

How much would it be to insure a Datsun 280zx for a 16 year old in NC.?

I have a mustang but v6 want a little more, but worried it might be to much to do right now.""

How much would insurance be for me if i have kawasaki zx10r and im a newbie?

Roughly how much will my insurance cost for a new mid-level sports car?

In California. Clean driving record. Car would be financed in the $30k - $40k range. I imagine I would want full coverage. Would it be substantially less if the car were a year or two old rather than new? Thanks! I have always had used cars in the past with just liability insurance.

I got a ticket for expired insurance in california?

but i did have insurance i just didnt have the card with me. the police officer said all i have to do is get the new card to the police station and have it signed off. am i going to still have to pay a fine?

Kawasaki Ninja 500R insurance?

Dose any one know how much the insurance would be on a Kawasaki Ninja 500R for someone that is about 18 with no accidents, or speeding tickets and good-ish grades?""

What car can i get as a 18 year old which wont kill me on insurance?

please help all the quotes i been getting are well above 5 grand , also if you got any tips or ideas on how to lower my insurance quotes that would be greatful""

Does anyone know any affordable cheap family plan health insurance company ?

i really need an affordable cheap family plan health insurance

How much would it cost to insure a 2002-2006 Subaru Impreza WRX for a 18 year old?

Just wondering, I'm looking into buying another car after I graduate High School. and I was wondering how much insurance cost per month to own a WRX between those years. For someone who has just graduated and turned 18.""

Do you approve or disapprove of the Affordable Healthcare Act?

And do you want it to become a reality or to disappear?

Car insurance prices?

i just got a 1993 BMW 325i for my 17th birthday. Can anyone tell me how much car insurance is going to be on it? i have a 2.5gpa so the discount doesn't apply. and i live in florida. Also how much does it cost to get your license plate and registration

How do people with serious health problems make it without health insurance?

I know that some people don't. But those of you who are in that situation and are doing okay, how do you do it?""

Should I get student health insurance or health insurance through my job?

I'm a fulltime student and I also have a fulltime job. Which would benefit me the most? Health insurance for students or health insurance that my job offers? Also, If I take 1 semester off from school would I still be eligible for student health insurance?""

How can we insure our car?

My feoncee and i bought a Car he lives in the state of WA and i live in OR about 30 minutes away. We bought the car here in Oregon. he bought it so he can teach me to drive i have my Learners permit and he is a WA licenced driver. he is going to be moving to OR after we get married so he doesnt want to change the Plates and such to WA. We need to insure the car before either of us can drive it. so the question is how can we go about this. He again is a Washington licenced Driver and i am in OR with a lerners permit the car is here in oregon and we need to put insurance on it

Around how much would insurance be if im 18 driving a ford 2000 GT Mustang and no driving record?

Any car insurance which insurances foreign cars?

Hi! I live in Italy and I am italian. I heard that there are some english insurance which insurance cars and people in foreign country. Is it real? do you know anything about that? Could you give me some advice about that? I am waiting your answers! Bye!

My friend got in a car accident he only had a permit did not have car insurance what will happen im court?

He went and hot his license an got car insurance now

How much will my car insurance probably be?

I'm 17 and one speeding ticket that resulted in four points on my record. I drive a white 545i bmw 2005, I rlly need to know bc I mite need to sale my car. Thanks""

Will the car insurance know?

I am a single parent, unemployed and I care for my eighteen month baby while my other child is at f/t school. I have recently passed my driving test and found the car that I want. The only problem is that the f/t course I applied for at college is full and the insurance premium is more for unemployed people and less for students!(which I can't understand). I can't tell them I am a housewife as I am not married, If I tell them that I am a f/t student will they need proof when I pay for the car insurance.""

""Fender bender, but did not have insurance?""

hypothetical situation, fender bender. I was in a fender bender, I was not the Fault person, but I did not have any insurance. Does the fault person insurance have to pay me for the damages done to my car even though I didn't have insurance when it happen? the insurance company refuse to pay me for any damages done to my vehicle. If I take them to court will I win. (the question is for me to know if I can get sued because my insurance company is not paying for the damages done to the other vehicle, but she did not have any insurance so they refuse to pay anything.)""

Cheap Car Insurance for a 20 year old...?

I'm 20 years old I live in Houston, Tx 77045 I have a 2003 Toyota Corolla CE. I never had accidents, or traffice tickets. I need a insurance that will not be so high. Any suggestions? Thanks..

https://www.linkedin.com/pulse/my-car-insurance-go-up-failure-stop-school-bus-ny-first-molter"

0 notes

kristinsimmons · 5 years

Text

Commissioning Healthcare Policy: Hospital Readmission and Its Price Tag

By ANISH KOKA MD

The message comes in over the office slack line at 1:05 pm. There are four patients in rooms, one new, 3 patients in the waiting room. Really, not an ideal time to deal with this particular message.

“Kathy the home care nurse for Mrs. C called and said her weight yesterday was 185, today it is 194, she has +4 pitting edema, heart rate 120, BP 140/70 standing, 120/64 sitting”

And so it comes to be that, days removed from a hospital admission, I’m sending her back to the hospital to be readmitted. According to some, this is not supposed to happen.

A policy on readmission

In 2008, the commission that advises Medicare – the Medicare Payment Advisory Commission (MEDPAC), issued a report that focused on hospital readmissions.

A complex analysis

But there’s more to this too good to be true story.

Gaming the metrics

Regardless of these technical considerations, it is an adage of social science that any metric will be gamed, and healthcare is unfortunately not immune to that law.

Source: MedPAC’s June 2018 Report (http://bit.ly/2CXD0fJ)

What do the outcomes data show?

A messy science

Admittedly this whole business of analysis is incredibly messy, with a number of moving parts.

Denying the obvious?

— Harlan Krumholz (@hmkyale) December 21, 2018

— Harlan Krumholz (@hmkyale) June 2, 2018

The MEDPAC conclusion also relies on an analysis that finds no correlation between hospital level readmission and mortality rates.

Conflicts of interest: You get what you pay for

As far back as 2003, Krumholz held the view that:

Yet the only clue to these payments in Krumholz’ published analyses of the HRRP program comes in one disclosure sentence in a footnote, as seen here:

It now becomes more clear why, in the following tweets, Dr. Krumholz feels that only he can say anything definitive about readmission rates and mortality:

— Harlan Krumholz (@hmkyale) December 26, 2018

6/Hospitals that have improved their readmission rates tended to improve their mortality rates. Published in @JAMA_current… https://t.co/R7FXLwTMPp

— Harlan Krumholz (@hmkyale) December 22, 2018

A diversity of biases

The story also highlights the downsides of tweaking healthcare systems that were built to deliver more care.

We are underestimating the downside of our current system when we contemplate change. We need to take some risks to do better. #abimf2013

— Harlan Krumholz (@hmkyale) August 5, 2013

Final Thoughts

Ironically, the HRRP quagmire offers a number of clarifying lessons.

As for Mrs. C, she has been home for 16 days. All fingers on both hands are currently crossed.

Anish Koka is a cardiologist in private practice in Philadelphia. He can be followed on Twitter @anish_koka. This post originally appeared here on The Accad & Koka Report.

Commissioning Healthcare Policy: Hospital Readmission and Its Price Tag published first on https://wittooth.tumblr.com/

0 notes

kristinsimmons · 5 years

Text

Commissioning Healthcare Policy: Hospital Readmission and Its Price Tag

By ANISH KOKA MD

The message comes in over the office slack line at 1:05 pm. There are four patients in rooms, one new, 3 patients in the waiting room. Really, not an ideal time to deal with this particular message.

“Kathy the home care nurse for Mrs. C called and said her weight yesterday was 185, today it is 194, she has +4 pitting edema, heart rate 120, BP 140/70 standing, 120/64 sitting”

And so it comes to be that, days removed from a hospital admission, I’m sending her back to the hospital to be readmitted. According to some, this is not supposed to happen.

A policy on readmission

In 2008, the commission that advises Medicare – the Medicare Payment Advisory Commission (MEDPAC), issued a report that focused on hospital readmissions.

A complex analysis

But there’s more to this too good to be true story.

Gaming the metrics

Regardless of these technical considerations, it is an adage of social science that any metric will be gamed, and healthcare is unfortunately not immune to that law.

Source: MedPAC’s June 2018 Report (http://bit.ly/2CXD0fJ)

What do the outcomes data show?

A messy science

Admittedly this whole business of analysis is incredibly messy, with a number of moving parts.

Denying the obvious?

— Harlan Krumholz (@hmkyale) December 21, 2018

— Harlan Krumholz (@hmkyale) June 2, 2018

The MEDPAC conclusion also relies on an analysis that finds no correlation between hospital level readmission and mortality rates.

Conflicts of interest: You get what you pay for

As far back as 2003, Krumholz held the view that:

Yet the only clue to these payments in Krumholz’ published analyses of the HRRP program comes in one disclosure sentence in a footnote, as seen here:

It now becomes more clear why, in the following tweets, Dr. Krumholz feels that only he can say anything definitive about readmission rates and mortality:

— Harlan Krumholz (@hmkyale) December 26, 2018

6/Hospitals that have improved their readmission rates tended to improve their mortality rates. Published in @JAMA_current… https://t.co/R7FXLwTMPp

— Harlan Krumholz (@hmkyale) December 22, 2018

A diversity of biases

The story also highlights the downsides of tweaking healthcare systems that were built to deliver more care.

We are underestimating the downside of our current system when we contemplate change. We need to take some risks to do better. #abimf2013

— Harlan Krumholz (@hmkyale) August 5, 2013

Final Thoughts

Ironically, the HRRP quagmire offers a number of clarifying lessons.

As for Mrs. C, she has been home for 16 days. All fingers on both hands are currently crossed.

Anish Koka is a cardiologist in private practice in Philadelphia. He can be followed on Twitter @anish_koka. This post originally appeared here on The Accad & Koka Report.

Commissioning Healthcare Policy: Hospital Readmission and Its Price Tag published first on https://wittooth.tumblr.com/

0 notes

kristinsimmons · 5 years

Text

Commissioning Healthcare Policy: Hospital Readmission and Its Price Tag

By ANISH KOKA MD

The message comes in over the office slack line at 1:05 pm. There are four patients in rooms, one new, 3 patients in the waiting room. Really, not an ideal time to deal with this particular message.

“Kathy the home care nurse for Mrs. C called and said her weight yesterday was 185, today it is 194, she has +4 pitting edema, heart rate 120, BP 140/70 standing, 120/64 sitting”

And so it comes to be that, days removed from a hospital admission, I’m sending her back to the hospital to be readmitted. According to some, this is not supposed to happen.

A policy on readmission

In 2008, the commission that advises Medicare – the Medicare Payment Advisory Commission (MEDPAC), issued a report that focused on hospital readmissions.

A complex analysis

But there’s more to this too good to be true story.

Gaming the metrics

Regardless of these technical considerations, it is an adage of social science that any metric will be gamed, and healthcare is unfortunately not immune to that law.

Source: MedPAC’s June 2018 Report (http://bit.ly/2CXD0fJ)

What do the outcomes data show?

A messy science

Admittedly this whole business of analysis is incredibly messy, with a number of moving parts.

Denying the obvious?

— Harlan Krumholz (@hmkyale) December 21, 2018

— Harlan Krumholz (@hmkyale) June 2, 2018

The MEDPAC conclusion also relies on an analysis that finds no correlation between hospital level readmission and mortality rates.

Conflicts of interest: You get what you pay for

As far back as 2003, Krumholz held the view that:

Yet the only clue to these payments in Krumholz’ published analyses of the HRRP program comes in one disclosure sentence in a footnote, as seen here:

It now becomes more clear why, in the following tweets, Dr. Krumholz feels that only he can say anything definitive about readmission rates and mortality:

— Harlan Krumholz (@hmkyale) December 26, 2018

6/Hospitals that have improved their readmission rates tended to improve their mortality rates. Published in @JAMA_current… https://t.co/R7FXLwTMPp

— Harlan Krumholz (@hmkyale) December 22, 2018

A diversity of biases

The story also highlights the downsides of tweaking healthcare systems that were built to deliver more care.

We are underestimating the downside of our current system when we contemplate change. We need to take some risks to do better. #abimf2013

— Harlan Krumholz (@hmkyale) August 5, 2013

Final Thoughts

Ironically, the HRRP quagmire offers a number of clarifying lessons.

As for Mrs. C, she has been home for 16 days. All fingers on both hands are currently crossed.

Anish Koka is a cardiologist in private practice in Philadelphia. He can be followed on Twitter @anish_koka. This post originally appeared here on The Accad & Koka Report.

Commissioning Healthcare Policy: Hospital Readmission and Its Price Tag published first on https://wittooth.tumblr.com/

0 notes