Physician Patient

Archive for June, 2017

Making Diagnoses From Afar: Heeding The Goldwater Rule

Tuesday, June 13th, 2017

Making psychiatric /medical diagnoses of citizens from afar absent their participation and consent is unethical, according to the American Psychiatric Association (APA)

In 1964 Barry Goldwater was characterized by prominent psychiatrists and many in the media as mentally deranged — satisfying criteria for a harsh psychiatric diagnosis. Scaremongering? Yes. Recall that (Lyndon Johnson promoted) “little girl with daisy atomic explosion” TV ad The Goldwater Rule was born in the aftermath of the 1964 election. It is now the ethical standard for psychiatrists and other professionals who are tempted to offer public “diagnoses” of President Trump or Hillary Clinton or others (name the politician) today.

Reasoning behind the Goldwater Rule may apply to labeling (diagnosing) all citizens from afar. Governments and insurance companies today mine data and apply algorithmic managed care criteria to individual episodes of a patient’s health care to decide on payment to clinic systems. UnitedHealthcare’s Optum claims it can achieve best patient outcomes by “coordinating” care using electronic health records (EHR) and quality criteria and rules. This a self-fulfilling prophecy if care cordination is defined by EHR linkages.

This sort of patient profiling from afar does not involve traditional insurance risk assessment which is neceaasary to set the price of an individual health care insurance policy and assessing the probability of an enrollee (based on her health conditions, history, or age) incurring future health care costs. In today’s world “medical necessity” is also purportedly measured by Minnesota’s government mandated health care ‘”quality indicators” . It is the “provider” who is now responsible for incurring health care costs. We need to know what the so-called quality assessment program actually costs Minnesota patients, doctors and taxpayers.

Government quality indicators actually already identify “low value health care.” Our current government policies supplant and override the diagnostic assessments and treatment recommendations to patients by independent physicians and other licensed health care professionals. And, to reconcile disparate professional assessments, set and enforce allowable payments for health care services, most Minnesota “healthcare providers” today must accept the rules of their hiring organizations. Or they are fired. Thus, “medical necessity” is now set by the hiring organization as a condition of continuing a “provider’s” employment. It follows that our corporate leaders now have an “administrative necessity” to build walls around their restricted and controlled “provider” networks. And Medicare, Medicaid and insurance companies are all seeking to transfer the management of the costs of health care for their patient populations to Accountable Care Organizations (ACO) such as Minnesota’s Hennepin Health and Allina.

The crunch is on for doctors and patients. The barbarians, so to speak, are inside the walls of our health care system.