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>> >>PEGGY: EARLIER THIS SUM THR SAN DIEGO TEACHERS UNION AND THE COUNTY BOARD OF EDUCATION
ENDORSED THE MEDICAL APPROPRIATENESS PROJECT. IT'S A PROGRAM THAT RATES DOCTORS BASED ON
THE CARE THEY PROVIDE WHILE OFFERING PATIENTS LOWER COST HEALTH CARE.
TO KS PLANE OW THE MAP PROJECT WORKS ARE MY GUEST GEORGE MEK MCGREGOR A HEALTH CARE ADMINISTRATOR
WHO DEVELOPED THE PROJECT, AND DR.ÊADAM DUDLEY. THANK YOU BOTH FOR BEING HERE.
GEORGE K YOU BRIEFLY EXPLAIN TO US THE BASIC OF THE MEDICAL APPROPRIATENESS PROJECT.
>> >>GEORGE MCGREGOR: FORTY FIVE SCHOOL DISTRICTS AND THEIR EMPLOYEE ASSOCIATIONS WERE SPENDING
120ÊMILLION DOLLARS, OF VERY PRECIOUS EDUCATION FUNDS TREATING DISEASES THEIR MEMBERS DON'T
V. THE RESEARCH PROJECT IS DESIGNED TO IDENTIFY THE INAPPROPRIATE DIAGNOSIS, IDENTIFY QUALITY
PHYSICIANS AND GET THEM PROPERLY TRAINED. >> >>PEGGY: PART OF IDENTIFYING HOW TO SAVE
MONEY IS A RATING SYSTEM THAT DR.ÊDUDLEY YOU ACTUALLY CAME UP WITH.
FELL TELL US HOW THIS RATING SYSTEM WORKS. >> >>DR. R. ADAMS DUDLEY: WE TAKE THE RECORDS
THAT DOCTORS FILE WITH THE INSURANCE COMPANY OR THE EMPLOYER AND GO THROUGH THEM LOOKING
FOR THAT IS NOT CONSISTENT WITH W WITH THE GUIDELINES.
>> >>PEGGY: GIVE US AN EXAMPLE OF THAT WHEN IT COMES TO, LET'S SAY CESAREAN SECTION.
>> >>DR. R. ADAMS DUDLEY: SO, A PARTICULARLY COMMON AND UNFORTUNATE TREND LATELY IS FOR
TO SCHEDULE C SECTIONS BEFORE YOU GET TO THE END OF THE PREGNANCY.
I THINK THIS IS MAINLY DOES BECAUSE IT SOUNDS LIKE IT COULD BE CONVENIENT, BUT IT TURNS
OUT IF YOU SCHEDULE IT TOO EARLY, IT'S SOMETIMES BAD FOR THE BABY AND THE MOM.
THEY'RE NOT READY. AND SO YOU NEED TO MOVE C SECTIONS BACK TO WHEN THE BABY'S DUE.
>> >>PEGGY: IS THERE SOME CONCERN OVER PEOPLE NOT DOING PROCEDURES THAT THEY NEED BECAUSE
THERE'S INCENTIVES TO THE DOCTORS TO AVOID COST OF PROCEDURES.
>> >>DR. R. ADAMS DUDLEY: AGAIN, WE'RE TRYING TO MOVE PEOPLE FOR THE RECOMMENDATIONS OF
THE SPECIALTY SOCIETY. SO WITH THE C SECTION EXAMPLE THE AMERICAN
COLLEGE OF OBSTETRICS AND GYNECOLOGY SAYS YOU SHOULDN'T DO IT BEFORE 39 WEEKS OF PREGNANCY.
THAT'S WHAT WE'RE LOOKING FOR. FIG PROCEDURES DONE BEFORE THAT.
PROCEDURES DONE AFTER THAT ARE COMPLETELY APPROPRIATE.
>> >>DWANE3: GEORGE, BLUE SHIELD TRY AD PHYSICIANS RATING IS AM FEW YEARS AGO, THE CALIFORNIA
MEDICAL ASSOCIATION SUED THEM. HOW ARE DOCTORS RESPONDING TO THIS PHYSICIAN
RATING SYSTEM? >> >>GEORGE MCGREGOR: THEY'RE RESPONDING ACTUALLY
MUCH BETTER. THE SYSTEM THAT DR.ÊDUDLEY HELPED COME UP WITH IS ACTUALLY A PHYSICIAN REPORTED
DATA. IT'S AUDITED BY THE STATE OF CALIFORNIA TO
MAKE SURE IT'S ACCURATE, AND IT'S GOT CLINICALLY BASED MEASURES.
SO IT'S FAR CLOSER THAN OTHER RATING SYSTEMS. >> >>PEGGY: HOW WOULD THIS, GEORGE, FIT IN
WITH EMPLOYERS EXISTING HEALTH CARE PLANS. IS IT ADDENDUM OR WILL WILL IT REPLACE IT?
>> >>GEORGE MCGREGOR: REALLY, NEITHER THE THE GOAL IS TO IDENTIFY GOOD QUALITY DOCTORS
WHICH THE EMPLOYERS CAN PLANT TO INCENTIVIZE THEIR MEMBERS TO GO TO, AND WE'VE GOT THREE
YEARS OF EVIDENCE. IF YOU GO TO A HIGH QUALITY DOCTOR AND GET
PROPERLY TREATED THE COST DECLINES SUBSTANTIALLY. >> >>PEGGY: DR.ÊDUDLEY K YOU GIVE US A FEW
EXAMPLES OF HOW THIS COULD SAVE IN HEALTH CARE COSTS.
>> >>DR. R. ADAMS DUDLEY: UH, IT CAN SAVE IN HEALTH CARE COSTS AND PREVENT COMPLICATIONS
FOR PATIENTS. FOR INSTANCE F YOU START HAVING LOWER BACK
PAIN, VERY COMMON PROBLEM IN OUR SOCIETY, AND YOU GO TO THE DOCTOR, THAT DOCTOR SHOULD
NOT SEND YOU OFF FOR AN X RAY RIGHT AWAY. THAT EXPOSES YOU TO THE RISKS OF THE PROCEDURE,
THE RADIATION. WHAT THEY SHOULD DO IS START REST, AND THEN
A GRADUAL PROGRAM EXERCISE AND WAIT AT LEAST SIX WEEKS TO START DOING ANY IMAGING.
THAT LOWERS YOUR RISK AND BILL AS WELL. >> >>PEGGY: HERE IN THE UNITED STATES, DRUD
DOCTOR DUDLEY, AS YOU KNOW, WE ARE AGGRESSIVE MEDICAL TREATERS.
DO YOU THINK THAT ST PART OF THE PROBLEM WITH HEALTH CARE COSTS?
>> >>DR. R. ADAMS DUDLEY: DEFINITELY. YOU DO MORE PROCEDURES THAN ANY OTHER DEVELOPED
SOCIETY, BUT DON'T GET BETTER OUTCOMES. FOR INSTANCE, LOOK AT PROSTATE CANCER YOU'LL
SEE THAT THE MAJORITY OF PEOPLE GET SURGERY AND RADIATION WHICH HAVE POTENTIAL COMPLICATIONS
HERE IN THE UNITED STATES. OTHER COUNTRIES PEOPLE OFTEN ARE JUST WATCHED
THE DEVELOPMENT OF COMPLICATIONS AND THEY DON'T DIE ANYMORE OFTEN.
>> >>PEGGY: OKAY, WE'RE RUNNING OUT OF TIME SO I WANT TO END WITH GEORGE Y HAVE A QUESTION
FOR YOU. HOW DO YOU SEE THIS MAP PROJECT WORK WITH
THE NEW HEALTHCARE REFORM LAW? >> >>GEORGE MCGREGOR: I SEE IT REALLY WORK
EFFECTIVELY WITH THE HEALTH CARE REFORM LAWS BY GETTING PEOPLE PROPERLY TREATED.
THEY WILL ACTUALLY LEAVE THE HEALTH CARE SYSTEM SOONER, AND WITH THE ADDITIONAL DEMANDS ON
THE HEALTH CARE SYSTEM AS A RESULT OF THE INCREASED ACCESS UNDER THE LAW, THERE WILL
BE THAT CAPABILITY FOR TREATMENT. >> >>PEGGY: GEORGE MCGREGOR AND DR.ÊDUDLEY,
THANK YOU BOTH FOR BEING HERE.