Value Added Medicine?: Movement on Doctor's Compensation Comes to NYS

Teachers are under attack. A major tool is the evaluation system, which improperly relies heavily on commercialized standardized test results. The test results do not take into account what some economists call externalities, factors external to the immediate teaching process? Is the student prepared? Does he or she attend class regularly and with attentiveness? Is the school tone, set by school administration, problematic? Has the administrator assigned the teacher a group of students with more challenged circumstances than students in other classes in the school? Does poverty impact on the student's life?

Despite the illogic of holding test results central to teachers' performance, this method is being steamrolled through, by policy makers, test-promoters and media pundits.

In New York State, outcome-based evaluations are being used to evaluate doctors. Doctors will be rated according to the patient's outcome after he or she leaves her or his office. The same poverty concerns enter into consideration. Does the patient live in a high pollution area? Does the patient's job have high stress? Does the patient experience classism, racism, sexism or homophobia? Does police frisking create stress in the individual's life? Are there affordable fruits and vegetables available in a supermarket in easy access to the patient's home? Are there affordable gym facilities available to the patient? Then, there are the lifestyle issues? Does the patient floss her or his teeth? Does the patient have a preference for a healthier diet? Does the patient exercise? Does the patient take recreational drugs or smoke? Does the patient bicycle without a helmet or reflective gear?

Is all of this the doctor's responsibility? Will doctors be responsible for the effects that externalities play upon the patient's life? Will the doctors avoid working with high-poverty clients? Will doctors find it incumbent to their income to push aside patients that neglect to handle his or her life with proper life-style choices?

The New York Times yesterday opened its front page story, "New York City Ties Doctors’ Income to Quality of Care," on the topic with:

In a bold experiment in performance pay, complaints from patients at New York City’s public hospitals and other measures of their care — like how long before they are discharged and how they fare afterward — will be reflected in doctors’ paychecks under a plan being negotiated by the physicians and their hospitals.

The proposal represents a broad national push away from the traditional model of rewarding doctors for the volume of services they order, a system that has been criticized for promoting unnecessary treatment. In the wake of changes laid out in the Affordable Care Act, public and private hospitals are already preparing to have their income tied partly to patient outcomes and cost containment, but the city’s plan extends that financial incentive to the front line, the doctors directly responsible for treatment. It also shows how the new law could change longstanding relationships, giving more power to some of the poorest and most vulnerable patients over doctors who run their care.

The article closed with quotes from various doctors citing the difficulties with the approach. Indeed, Dr. David Himmelstein, professor at the City University of New York and a visiting professor at Harvard Medical School noted, “The consequences in a complex system like a hospital for giving an incentive for one little piece of behavior are virtually impossible to foresee.”

But Dr. Himmelstein said there were still hazards in the city’s plan. He said that when primary-care doctors in England were offered bonuses based on quality measures, they met virtually all of them in the first year, suggesting either that quality improved or — the more likely explanation, in his view — “they learned very quickly to teach to the test.”

“I think the most interesting finding is, things that were not measured, in a few studies, appeared to have gotten a bit worse,” Dr. Himmelstein said. For instance, patients were not as likely to stick with the same doctor, possibly because they were encouraged to see whichever doctor was available — speed was one quality measure — rather than the doctor who might know them best. In another example, while the doctors reported that they had controlled blood pressure in virtually all their patients, a random survey showed no downward trend in blood pressure or strokes.

There could have been any number of ways of outsmarting the system, he said: “If you take blood pressures three times and report the lowest, is that lying or merely tipping the numbers in your favor?”

Dr. Himmelstein also said doctors could try to avoid the sickest and poorest patients, who tend to have the worst outcomes and be the least satisfied. But physicians within the public hospital system have little ability to choose their patients, Mr. Aviles said. He added that he did not expect the doctors to act so cynically because, “in the main, physicians are here because they are attracted to that very mission of serving everybody equally.”

LI's Newsday: Teacher evaluation systems proving costly

Teacher evaluation systems proving costly

Originally published: November 22, 2012 8:39 PM
Updated: November 22, 2012 9:27 PM
By JO NAPOLITANO jo.napolitano@newsday.com

The newly mandated teacher and principal evaluation system is costing Long Island school districts tens of thousands of dollars per year in training, testing and materials, even as they struggle with effects of the property-tax cap and putting in place other required education reforms.

The expense varies by district depending on its size and how it plans to satisfy the state's demands.

Go to the Newsday site for the remainder of the article.

NY Times / CBS News Poll: Bloomberg's Support at Lowest in Six Years

The New York Times reported today, August 16, 2011, that New York City Mayor Michael Bloomberg's popularity ratings are at their lowest this month, since six years ago:

"Poll Finds Bloomberg’s Approval Rating the Lowest in 6 Years."


We have to remember that the last times that New York City's mayor had such low ratings among polled city residents was in the 2002-2003 period, when the region was still recovering from the economic effects of September 11 and before that the bursting of the Dot Com Bubble.

Read through these numbers of New York City mayors' poll numbers. The views on mayoral job performance and condition of the city's economy have not been so unfavorable since 2003.

Read the full story by David W. Chen and Marjorie Connelly in "The New York Times."

Diana Williams teaches Mulgrew that new rating system will lead to teaching-to-the-test

So pathetic: A broadcast journalist has to point out to United Federation of Teachers president Michael Mulgrew that the new teacher evaluation system (with plenty of observations --thanks, Ed Notes-- of what the system will mean, in action) will lead to more test-prep as "teaching":
http://abclocal.go.com/wabc/video?id=7444645&pid=7444663
On Sunday, May 16, 2010, WABC-TV's Diana Williams pointed out that the new rating system, with its placing 40 percent of a teacher's evaluation on student performance on standardized test performance, will lead to more teaching-to-the-test.
The lame UFT president evaded that point.

Does anyone in the media ever consider the pitfalls of test-emphasis when so many factors are generally beyond a teacher's control, such as whether a student actually shows up to class?

Pertaining to the last point above, note these comments in reaction to a Washington Post article, "Is the public turning against teachers unions?":

if teachers had to deal less with bad parenting (behavior, morals, discipline, work ethic, etc...) and ineffective administrative practices (rules with unrealistic or little punishment, false threats, etc...) then we would be a little less "bad". i am SICK and tired of not having my students show up to school regularly, on time, with materials, and willing/ready to do any work. i guess it must be because i'm a bad teacher and has nothing to do with the fact that most of my students have no accountability nor support from home to push them to appreciate an education.

(Granted, the lower case first-person "i" doesn't look good.)

Could your observations and performance ratings play havoc with your health?

Tara Parker-Pope, writing last Tuesday, May 17, 2010, in "The New York Times" wrote on "Time to Review Workplace Reviews?."

You think your administrator is tough? And that performance evaluations are petty and arbitrary?
As Parker-Pope wrote, you're not alone. And both health and management experts think that they are both overrated and often detrimental to workers' physical and emotional health.

OVERWHELMING STRESS PRODUCED:

A number of studies have documented the health toll of workplace stress, showing that unhappy workers are at higher risk for heart problems and depression, among other things. This month, Danish researchers reported on a 15-year study of 12,000 nurses finding that nurses struggling with excessive work pressures had double the risk for a heart attack. And a British study tracking 6,000 workers for 11 years found that those who regularly worked more than 10 hours a day had a 60 percent higher risk for heart disease than those who put in 7 hours.

Samuel A. Culbert, a clinical psychologist who teaches at the Anderson School of Management at the University of California, Los Angeles, says too many people work in a “toxic” environment, and the title of his new book (from Hachette) throws a spotlight on one of the culprits: “Get Rid of the Performance Review!”

Annual reviews not only create a high level of stress for workers, he argues, but end up making everybody — bosses and subordinates — less effective at their jobs. He says reviews are so subjective — so dependent on the worker’s relationship with the boss — as to be meaningless. He says he has heard from countless workers who say their work life was ruined by an unfair review.

“There is a very bad set of values that are embedded in the air because of performance reviews,” he told me.

. . .

Frank Cordaro, 56, of Ontario, N.Y., said years of good performance were undone by one bad review from a new manager. He refused to sign the review and ended up taking medication to cope with the anxiety and stress at work. Eventually he lost his job.

“It played hell with my physical health, my mental health, too,” said Mr. Cordaro, adding that he is much happier since he started his own business. “When you’re always fearing for your job, it’s not a good situation.”

Gary Namie, director of the Workplace Bullying Institute in Bellingham, Wash., says office bullies have been known to use performance reviews to undermine a worker.

“I say, ‘Throw it out,’ because it becomes a very biased, error-prone and abuse-prone system,” said Dr. Namie, the author of “The Bully at Work” (Sourcebooks, 2000). “It should be replaced by daily ongoing contact with managers who know the work and who can become coaches.”

GRINNING (or GRITTING) AND BEARING CRUEL BOSSES:

And bad bosses are an enormous source of stress. In one British study of nurses, workers who didn’t like their supervisors had consistently elevated blood pressure throughout the workday.

Although there is little an individual can do about such a boss, the American Psychological Association offers some tips, including finding a mentor within the company to discuss strategies for dealing with a problem supervisor.