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I have mixed feelings about impromptu meals out. On one hand, any food is good food, unless if it?s bad food. But on the other hand it almost definitely means that I won?t have my camera with me, so when a particularly photogenic food item comes out, my level of angst is roughly that of an OCD sufferer with their faces pressed under the putrescent waters of obsession. ?
?So anyway, the plan was to see the new Pixar movie, Brave, with my sister last Tuesday. Except when we rocked up the tickets have all but sold out, so we scratched that plan and decided treat ourselves to Dessert Story instead. And it just so happens that it?s happy hour every day from 12-3pm across all stores, where everything on the menu is 15% off ? SCORE.
?
The first dessert we had was the Mango Sago in Coconut Milk ($5.5). Even though it?s served in a bowl, it?s more of a sweet and rich coconut drink with small chewy pearls of sago. The scoop of mango puree floating in the middle was a refreshing, fruity addition to the tropical flavours. We both enjoyed this immensely.
The other dessert we had was the Mixed Pudding with Grass Jelly and Pearl ($5.5). Shiny, quivering slabs of pudding in jewelled hues were splayed over a bowlful of shaved ice that was drizzled in sweet, herbal syrup. Each spoon was a textural playground of crunchy ice and slippery pudding and chewy pearls. Unfortunately the puddings lacked a little in the flavour department; my sister and I agreed that the milk pudding tasted a lot like medicine, but overall this was still quite a successful dessert.?
And just so you all know, the prices I?ve listed in this post are before the 15% discount, so our bill actually only came to $9.35 for both desserts, which is really really good, considering our stomachs were sloshing with excess dessert by the end. ??
Rating: 14/20 ? making friends with asian desserts.?
Performance pay for physicians may backfire: BMJ editorialPublic release date: 14-Aug-2012 [ | E-mail | Share ]
Contact: Mark Almberg mark@pnhp.org 312-782-6006 Physicians for a National Health Program
Pay-for-performance schemes may do more harm than good by changing the mindset required for good doctoring, experts say
In a cautionary editorial alongside a related article in today's issue of the British medical journal BMJ, leading experts in health policy and behavioral economics argue that pay-for-performance (P4P) schemes which financially reward doctors and hospitals for hitting specific, numerical targets in such matters as preventing hospital readmissions or prescribing certain drugs are likely to do more harm than good.
Such schemes are being adopted as a key component of the Accountable Care Organization strategy mandated by the 2010 health reform and are now part of the Medicare program, Massachusetts' cost-control legislation and virtually all major new private health insurance payment contracts.
Yet the editorial, echoing a theme of the accompanying article, says there's very little evidence that P4P has improved patient survival or any other measure of public health.
"Despite a dearth of robust evidence that P4P is clinically effective in health care, payers charge ahead with implementing everywhere an intervention that has proven to work nowhere," the authors write.
Worse still, there is mounting evidence reinforced by the latest findings in behavioral economics that such schemes may actually do harm, the authors say.
For example, doctors and nurses may perceive detailed, overly prescriptive financial P4P contracts as "controlling," which can cause them to dissociate from their work, lose their intrinsic motivation to do their very best for the patient, and engage in gaming the medical equivalent of "teaching to the test."
According to the authors, such gaming e.g. "upcoding" a diagnosis to another condition that yields a higher payment is already rife. For instance, labeling a pneumonia patient's condition as "complex" rather than "simple" can increase the hospital's payment by 42 percent.
"Pay for performance inverts medical priorities, making care an instrument for generating money, rather than vice versa," said Dr. David Himmelstein, professor at the City University of New York's School of Public Health and senior author of the editorial. "It can mutate honesty and altruism into accounting and legal trickery."
Dan Ariely, James B. Duke Professor of Psychology and Behavioral Economics at Duke University, co-author of the editorial and the author of numerous research studies and three bestselling books on behavioral economics, including "The (Honest) Truth about Dishonesty," said: "Several studies show that while performance-based rewards can increase output for straightforward manual tasks, they can undermine motivation and actually worsen performance on complex cognitive tasks, such as those required in medicine. The unintended consequence is likely a worsening of care, not its improvement."
Lead author Dr. Steffie Woolhandler, also a professor at CUNY's School of Public Health, noted another hazard: Some physicians in safety-net hospitals may score poorly because of circumstances beyond their control, such as their institution's financial distress. "In such situations, penalizing low-scorers can make matters worse, effectively punishing patients who have nowhere else to go," she said.
Himmelstein and Woolhandler are also visiting professors of medicine at Harvard Medical School and the co-founders of Physicians for a National Health Program, an organization of 18,000 doctors who advocate for a single-payer health care system. PNHP played no role in supporting their research.
The editorial concludes, "We worry that P4P may simply not work because it changes the mindset for good doctoring. However, if P4P schemes must be envisaged then rigorous consideration of their likely benefit prior to their implementation seems essential," referring to an exacting P4P checklist developed by the authors of the related article.
###
"Why pay for performance may be incompatible with quality improvement," Steffie Woolhandler, M.D., M.P.H., Daniel Ariely, Ph.D., David U. Himmelstein, M.D. BMJ, Aug. 15, 2012. An advance copy of the EMBARGOED article is available to media professionals on request.
The related article:
"When financial incentives do more good than harm: A checklist," Paul P. Glasziou, Heather Buchan, Chris Del, et al. BMJ, Aug. 15, 2012.
[ | E-mail | Share ]
?
AAAS and EurekAlert! are not responsible for the accuracy of news releases posted to EurekAlert! by contributing institutions or for the use of any information through the EurekAlert! system.
Performance pay for physicians may backfire: BMJ editorialPublic release date: 14-Aug-2012 [ | E-mail | Share ]
Contact: Mark Almberg mark@pnhp.org 312-782-6006 Physicians for a National Health Program
Pay-for-performance schemes may do more harm than good by changing the mindset required for good doctoring, experts say
In a cautionary editorial alongside a related article in today's issue of the British medical journal BMJ, leading experts in health policy and behavioral economics argue that pay-for-performance (P4P) schemes which financially reward doctors and hospitals for hitting specific, numerical targets in such matters as preventing hospital readmissions or prescribing certain drugs are likely to do more harm than good.
Such schemes are being adopted as a key component of the Accountable Care Organization strategy mandated by the 2010 health reform and are now part of the Medicare program, Massachusetts' cost-control legislation and virtually all major new private health insurance payment contracts.
Yet the editorial, echoing a theme of the accompanying article, says there's very little evidence that P4P has improved patient survival or any other measure of public health.
"Despite a dearth of robust evidence that P4P is clinically effective in health care, payers charge ahead with implementing everywhere an intervention that has proven to work nowhere," the authors write.
Worse still, there is mounting evidence reinforced by the latest findings in behavioral economics that such schemes may actually do harm, the authors say.
For example, doctors and nurses may perceive detailed, overly prescriptive financial P4P contracts as "controlling," which can cause them to dissociate from their work, lose their intrinsic motivation to do their very best for the patient, and engage in gaming the medical equivalent of "teaching to the test."
According to the authors, such gaming e.g. "upcoding" a diagnosis to another condition that yields a higher payment is already rife. For instance, labeling a pneumonia patient's condition as "complex" rather than "simple" can increase the hospital's payment by 42 percent.
"Pay for performance inverts medical priorities, making care an instrument for generating money, rather than vice versa," said Dr. David Himmelstein, professor at the City University of New York's School of Public Health and senior author of the editorial. "It can mutate honesty and altruism into accounting and legal trickery."
Dan Ariely, James B. Duke Professor of Psychology and Behavioral Economics at Duke University, co-author of the editorial and the author of numerous research studies and three bestselling books on behavioral economics, including "The (Honest) Truth about Dishonesty," said: "Several studies show that while performance-based rewards can increase output for straightforward manual tasks, they can undermine motivation and actually worsen performance on complex cognitive tasks, such as those required in medicine. The unintended consequence is likely a worsening of care, not its improvement."
Lead author Dr. Steffie Woolhandler, also a professor at CUNY's School of Public Health, noted another hazard: Some physicians in safety-net hospitals may score poorly because of circumstances beyond their control, such as their institution's financial distress. "In such situations, penalizing low-scorers can make matters worse, effectively punishing patients who have nowhere else to go," she said.
Himmelstein and Woolhandler are also visiting professors of medicine at Harvard Medical School and the co-founders of Physicians for a National Health Program, an organization of 18,000 doctors who advocate for a single-payer health care system. PNHP played no role in supporting their research.
The editorial concludes, "We worry that P4P may simply not work because it changes the mindset for good doctoring. However, if P4P schemes must be envisaged then rigorous consideration of their likely benefit prior to their implementation seems essential," referring to an exacting P4P checklist developed by the authors of the related article.
###
"Why pay for performance may be incompatible with quality improvement," Steffie Woolhandler, M.D., M.P.H., Daniel Ariely, Ph.D., David U. Himmelstein, M.D. BMJ, Aug. 15, 2012. An advance copy of the EMBARGOED article is available to media professionals on request.
The related article:
"When financial incentives do more good than harm: A checklist," Paul P. Glasziou, Heather Buchan, Chris Del, et al. BMJ, Aug. 15, 2012.
[ | E-mail | Share ]
?
AAAS and EurekAlert! are not responsible for the accuracy of news releases posted to EurekAlert! by contributing institutions or for the use of any information through the EurekAlert! system.
Hello, please call me Nicole! I'm super nice and love to roleplay so it would be great to find a long term partner and collaborate some great roleplays together. I hope to hear from some of you soon!! Now, I'm going to cut to the chase and post the rules and genres.
Rules: 01. Be LITERATE. Correct spelling, punctuation, and all of that. I except at least two paragraph responses, though I know dialogue posts will be short, and certainly no one-liners. Give me something to work with and I'll do the same for you. Quality over quantity. 02. Be polite. There is no reason to be rude over the internet. That's ridiculous. I like to make relationships with my partners in hope of keeping them long-term. 03. I have no limits and like a lot of romance. Tell me your limits and I will respect them. 04. I understand that all females like to play females, and I'm not disagreeing that I prefer it as well. However, I do prefer that we try to double if we cannot come up with some sort of agreement. I don't like having the male role pushed on my as it has been many many times. I don't mind playing a male, but don't abuse it. This is why I prefer we double. 05. When role-playing something based off a movie, book or something of the sort, I prefer for us to use our own characters. I hate playing up expectations and being disappointed if one of us cannot interpret them correctly. 06. BE CREATIVE.
Genres: Competitive Stable Harry Potter. The Hunger Games X-Men (any of the movies) Fable Percy Jackson and the Olympians Assassins Creed The Kane Chronicles Pokemon. Super Smash Bros Meele/Brawl. Yu-Gi-Oh. The Legend of Zelda. Avatar: The Last Airbender/Legend of Korra. Pirates of the Caribban. Lord of the Rings. Ancient Egypt Ancient Greece/Rome Spellcasters. Mythical Creaturs. Odd Pairings.
** This is just a condensed list. If you want to roleplay something that is not on here, please feel free to share your idea with me! Chances are that I won't reject you!
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Public release date: 14-Aug-2012
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