I went looking for a widget, only to find there were many kinds of the same widgets in the store. So, I asked which widget would work the best? The savvy salesperson answered with a question of his own, “What is it that you need it to do?” I listed some required needs and he ushered me to a stall with 3 different kinds of almost similar widgets. “Which one has more value for you?” he asked inquiringly. Hmm…after much finger, thumb Rodin-like expression, I picked up the shiny digital one over the battle-tested raw metallic one. Needless to say that 24 hours later, I was back asking for a replacement widget.
Based on Need
The term “Value” is a nebulous cloud of molecules that only collide to create an image based on the individual’s perception. You might consider the following thought experiment; Do you value Ford over than GM? The answer might surprise you. And there are many imputed variables there to bring about a rational and satisficing decision. Or better yet a decision between a Coupe and a SUV is based on need but between the many different kinds of SUV lies a choice and that is also fulfilled by desire and need. Or an even more extreme version of “Value” lies in a bottled water. At an airport you will find scores of cylindrical, squarish, small, medium and large, colored or plain bottles touting the freshest, most delicious water for your flight. Which one has value to you is based on your hierarchical metric of this amorphous thing called “value.”
Based on Armchair determination
By now you might have conjured up the concept that “value” probably lies in the eyes and mind of the beholder. While somethings might have “Value” to one person it might not for another. Since we all come with our own suitcases full of predestined baggage, acquiring loads and loads more as we move through time. Thus “Value” differs with different phases of life and time. In some cases, finances are involved, in others aesthetics, in still others pure function and lastly for some pure unadulterated desire and want.
But that is not what the “Experts” from the Elite School of “We are the Experts” like Slavitt, Gruber and Emanuel, have come to the conclusion. They have been screaming from the rooftops that in medicine, value is based on the outcome related to therapeutics offered. Hmm, okay, now let’s take a chill pill before we go answering to this loco-motivational self-righteous morality-signaling bunch’s point of view in medical care.
Based on Marketing and Promotion
The bluntness is partly a function of the historical mess these “experts” have created and partly because they have made a mockery of the philosophical integrity of the Value Theory. This theory states that Value is divisible into “Moral Value” as in those belonging to the character of an individual and “Natural Value” as those belonging to an object. A “good person” versus a “Good thing.” Ok, I admit it is just a theory, nonetheless it has some gravitas. These “experts” have cunningly crafted a meme that seals both those disparate values into a combined whole where attempts to void inseparability, destroys both. Let me give you an example… The term “Public Good” is designed to make you think that some virtue is at stake, if whatever is recommended is not done, but look deeper and you realize that it is manifestly only good for the “Public employee” their promotion and pay check and potentially a disaster for the private person or his/her ruin. Merging the two “Values” has come to claim at least one life recently, i.e. Alfie Evans in the UK under the aegis of the National Health Services (NHS). These memes crafted as they are, are designed to assuage the softer minds in all of us; words to comfort but deeds to actually destroy is their credo. (
Read Here)
These minions serving bigger minions have combined the Business lexicon into their empathic virtuosity vocabulary. They have merged Value with Metrics. Please do not snark at this. Look up the two words individually or collectively and you will understand the goal of the oft repeated and revered term “Value Metrics.” Look deeper and you will find it embedded in all forms of Healthcare discussions. Why? Because, starting a conversation from that baseline leads to the merger of the “Moral Values” and “Natural Values.” If you start there, then the merged premise becomes the anchor and the frame of reference. (Definition:A value metric (also called a pricing dimension or a pricing axis) is basically the foundation of your pricing model).
Medicine is both an art and a science. Do you agree? If you don’t, perhaps you might consider reading something else, since your mind is already made up. But if, if you do agree that there is Art in medicine, then stay with me, friend and we shall explore this a bit further.
Assume two patients, both diagnosed with the same bacterial pneumonia are admitted to the hospital for their care. Both of equal age, one with more vigor than the other. Both treated with similar and appropriate antibiotics. The less vigorous one responds while the other requires additional resources to circumvent this rapidly multiplying micro-monster in her blood stream that has established a beachhead and breached the immune surveillance defense. In the eyes of the “Experts”, especially those that sit in cubicles and do some patchwork of “billing denials” (to the order of 12% of all medical bills) in order to thwart the requesting physician from receiving a timely payment for services rendered. The complex world of the medical industrial complex, has now become the norm. That denial keeps the “Time Value of Money” squarely for the agency (Insurer) and creates 6-12 weeks of Medical Revenue Cycle (wait period) for the Physicians who struggle to meet the payroll. Permanent denials are also handed out because “Value” in the eyes of the “experts” has not been met by the requesting billing physician and if you fail to challenge, you don’t get anything period. Failing to challenge is easy when you are a hamster in the wheel, working 12 hour days and managing this complex medical arcade. In actuality, given the above scenario, both patients survive the onslaught of their malady, one’s stay was less expensive than the other. The authorities deem the longer stay as the physician’s lack of good care and absence of average skills to manage the condition appropriately. After all, how can the frail person recover quickly while the robust one had 3-4 extra hospital day stay? It must be the physician’s fault.
You might think the same, if you were not well versed in the nuance of each patient’s biology. But reflect on the fact that a minor mutation of one’s gene might have trifled with the protective white cells functional ability to defend against the onslaught. And therefore, the response of one exceeded that of the other. The “Value” as determined by the person in the cubicle was expense based on “Value-Metric” and not the breach in the immune surveillance. Not being educated, how would he or she ever know such a nuance? This faceless person is doing the bidding of the customized checklist manifesto. A manifesto granted him/her by the hierarchy, designed algorithm from a set of other algorithms, strictly based on the IFTTT (IF This Then That) and cost the department, division and the Insurer (Government/Private) oodles of money had to be accurate. Ah, and here these agencies tout, “no emotional Homo Sapien element was involved in the denial process.” What utter malarkey!
Based on Mandates & Regulations
“Value” as breathed by the “experts” is a relative term and the relativity is based on the hard and finite resource of money, read “Value Metrics.” It has very little to do with the rendered care or the nuance of individuality dealt expertly by the physicians rendering the care. But alas legion of Twitterati, Facebook and Instagram followers are already sending reams and reams of digital information touting the benefits of such “Value Metrics.” After all they ask themselves, resplendent in their googled knowledge and fully vested with the simple concept of “Less is More” therefore “More is necessarily Less” and therefore should not be “gifted”/reimbursed in any way. They forget that “Less is More” applies to a knowledgeably determined need of an individual and not a capriciously based algorithm combined with a useful idiot punching keys. Less diagnostics have a place in medical care, but less needed therapy has no place in society. Life cannot and should not be equated to money. Equating the two is a slippery slope and leads to life-long trauma on the well-being of an entire society. There is definite need to circumvent frivolous care. But there is no need to reject appropriate care on the bases of cost.
Based on Mandated Outcomes
Another case in point is the Hospital Readmission Rate used to redefine “Quality,” a primary metric (or as previously mentioned of “Moral Value” implying, lesser the rate of readmission means better care apportioned) and then as “Natural Value” (less cost to the insurer and the government) as a secondary metric. It turns out, after this mandate was enforced on Hospitals, the heart failure death rate rocketed up. More people were left to die without care because readmission was frowned upon and the patients if they did attempt to go to the hospitals in distress, were discharged before 24 hours (not considered an admission) or simply turned away from the Emergency Department of the Hospitals. After careful analysis, not a whole lot of “Natural Value” was saved from this “expert’ meme, because legions of more administrative staff were needed to oversee the mandate, but a lot of “Moral Value” was lost. (
Read Here)
Based on Minions
And as I have often hollered through my words. The “Cost of Medical Care” in these the United States is not based on the care rendered. It is mostly from the administrative minion costs, be that at the insurer level, government level or at the medical practitioner level. All contribute to the $3.4 Trillion annually. Here again the “Natural Value” of blaming the physicians for the high cost of care is hidden behind the “Moral Value” of virtue signaling by the Insurers and the public policy managers who do not want the attention focused on their paychecks and their “paper pushing techniques.” And by the way, seriously, if one wanted to get all these fat cats and their administrators out of healthcare, the cost of healthcare in the US would drop by at least 1/3
rdif not ½. (
Read Here)
For now, like the salesman that I met, “Value” lies in the eyes and the pockets of the moneybag “Holder.”
