20 August 2007

Medicare puts the squeeze on hospitals

We saw this coming well down the pipeline:
Medicare says it won't pay for hospital errors

It's the next logical step in pay-for performance. The goal is laudable and the effect will probably be beneficial, but it is a little frustrating to view from this side of the fence. Medicare insiders will tell you quite frankly that while they (as we) view patient safely/quality of care as the highest priority and ultimate goal, these measures are being instituted with the underlying intent of cost containment. They know that any overt reductions in reimbursement will provoke a backlash from providers (including facilities), many of whom are politically well-enough connected to block it. But by linking the payment reductions to real or supposed deficiencies in quality, it creates a situation in which providers cannot oppose them without seeming to oppose patient safety initiatives, which is simply not tenable, politically. It's a catch-22.

And don't think that the physician reimbursements won't wind up encumbered in the same way, sooner or later.


  1. Yep, it's a toss up : lawyer / politician / insurance administrator. Still haven't clarified it for myself yet.

    Have a good day ;-)

    First Law: The Art of Medicine consists of amusing the patient while nature takes its course.

    Second Law: It is impossible to make an asymptomatic patient feel better.

    Third Law: The urgency of the test is inversely proportional to the IQ of the insurance company pre-authorisation clerk.

    Fourth Law: No good deed goes unpunished.

    Fifth Law: A patient's acceptance of a screening test is inversely proportional to its necessity for that particular patient.

    Sixth Law: Trauma survival is inversely related to the patient's value to society.

    Seventh Law: Fertility is inversely proportional to intelligence.

    Eighth Law: The better the surgeon, the more reluctant he/she is to operate.

    Ninth Law: Part A: It has to be fun. Part B: If it isn't fun, see Part A.

    Tenth Law: "Simple" and "Easy" are not necessarily the same.

    Eleventh Law: Poor planning on your part is not an emergency on my part.

    Twelfth Law: A bad idea held by many people for a long time is still a bad idea.

  2. I think it is a good step, but I do sympathize with your position. We definitely need to do something to re-invigerate our system. We have neglected it to the point were people are forgoe-ing care and our seniors are going to foreign pharmacies to afford their medications.

  3. How do you reconcile this with your enthusiasm for single payer? I don't mean this to sound confrontational--you're an excellent thinker and I'm interested in your opinion.

  4. My concern is with the concept of "errors." Some things are controllable and others not. A patient staying at facility (or hospital) is looked over by several entities . . . nursing staff, PCP, consulting physicians, and let's not forget friends and family. Who is responsible . . . let's say for the simple case of MRSA (which is one of the charter six errors) that may develop as a skin lesion?

    Not everything in a hospital environment has a single controlable source.

    Contaminated bed rails, contact with who knows how many individuals during the stay, self infected courier, or any other source . . . Who will get penalized? Hospital, PCP, nursing staff . . . It's a very complex situation.

    CA-MRSA is on such a dramatic rise in my area I can't even imagine the implications of this new outlook.

    With the list expected to become even larger . . . the implication for primary care can be astounding. This may make many to choose hospitalist services for inpatient management and let them absorb the risk.

    Just some initial thoughts


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