Critical Thinking

The Game of Healthcare

When I first entered this profession, I interviewed at several local private practices for my first gig.  I eventually chose a national chain because it afforded me the opportunity for formal mentorship and management education.  I wanted to learn better care for my patients;  I had little insight on the developing game.

Since that time, many of the private practices I talked to have been acquired by larger chains or the two integrated delivery financial systems (UPMC & Allegheny Health Network) that exist in the region.   This is due to payers narrowing their network and formulating updated payment structures which are built upon a combination of outcomes and bundled payments.   A changing landscape in preparation for “The Game of Healthcare“.

While I left the outpatient sector 4 years ago for Home Health, the turf and players are the same.  Value-based purchasing is currently the buzz on our field and assessing each of your clinicians influence over our outcomes tool, the OASIS, is how we are evolving.  Clinicians are being graded on their ability to achieve certain outcome measures, which Medicare (and others) have deemed important.   Analytics software, such as SHP, attributes a grade to each clinician and evaluates how they compare against others in the region.

My crew has become a sports team in the Home Health League, each carrying their unique set of skills to influence the score (our OASIS score at discharge) to win the game. Maintain a decent batting average, and your value increases.   Strike out a few times and your susceptible to getting cut.

The stats on the back of your card if you play in my league:  Hospital Readmission Rates, Improvement in Pain Interfering w/ Activity, Improvement in Ambulation, Improvement in Bed Transfers, etc.

So will this game result in improved care?  I hope so.  I am cautiously optimistic.  I suspect it will help us focus on variables which increase healthcare over utilization and costs.

Have you began preparation for this game?   What have been your experiences?


Prepare your team for improvements in care by checking out the educational offerings at  (current sales on Online Courses)



Categories: Critical Thinking

8 replies »

  1. Joseph, I hope crews such as yours are being marked down on their score cards whenever they offer modalities of treatment that not only are devoid of a rational scientific theoretical basis but also have not been shown to produce therapeutic outcomes that are any better than placebo treatment – “trigger point dry needling” being an outstanding case in point.

  2. Dr. Quintner, Your comment is quite odd. My team does not offer dry needling. As I stated in the article, the name of the game is outcomes—which should improve clinical reasoning (especially as you race to decrease utilization of care).

  3. Joseph, I am pleased to learn that your team does not offer dry needling. However, according to its advertising, the organization which you represent (as Vice-President of Operations) does offer this modality of treatment. Please correct me if I am wrong about this. By the way, in my opinion, clinical reasoning comes before treatment outcomes. When clinical reasoning is based upon flawed theory (as in “dry needling”), measuring outcomes is a waste of time and effort.

  4. My company, NxtGen, does have a strategic partnership with Myopain Seminars, but we do not directly teach any dry needling courses or content. And yes, sound clinical reasoning does come first. Outcomes, as measured by payers, are broad and encompass concepts such as acute care readmissions.

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