Coincidently, I was lecturing last week at the Home of Guideline study, Dartmouth (at the Tuck Business School). I talked about how studies in the 1980s by Drs Wennberg, Zubkoff, and others argued for the establishment of national guidelines. Why? The goal was to diminish the substantial variation of physician practice and recommendations for different reasons in regions across the country.
Thirty years later, we now have a (dare I say) bastardization of that principal as described in this article. Payers, health plans, MCOs, etc. require their own selected and favorite pathways that may differ across each patient frequently in terms of recommended treatments, including preferred treatments. Oncology practices must juggle multiple, disparate recommendations depending on the insurance that a patient may carry or that MCO picked by a payer to manage that patient.
The circumstance of the multiple guideline/pathways recommendations that oncology practices have to juggle belies the concept of a National Guideline that unifies and directs best patient care. Anybody ever hear of the letters NC?
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