For contrary views on yesterday’s post on the new Medicare payment rules — see the new blog, The Physician Executive, and see Paul Levy’s blog entry from Sunday, especially the followup discussion and comments — click here for that.
Tonight, we hosted a quality of care discussion in Framingham for folks from the Metrowest region. Linda Campbell, Director of Quality and Patient Safety at Metrowest Medical Center told me two facts I had missed in all the discussion: 1. the rule takes effect on 10/1/08 giving hospitals about 13 months to prepare, and 2. the full rule runs about 2,000 pages. Yikes!
I appreciate the concerns about the difficulties hospitals will face implementing this new structure, and recognize that some degree of gaming is inevitable and will undermine the ultimate effectiveness of this rule. At the same time:
1. We know that hospitals around the nation — especially Michigan — have driven their rates of infection down to ZERO. No one says it’s easy, but as Lucian Leape says, the cat’s out of the bag on this one. And he’s been saying that for over two years now.
2. We’ve all seen news accounts of the Pennsylvania hospital chain that is guaranteeing consumers and payers will not have to pay for hospital mistakes.
3. Where else in the American economy is there a sector that derives revenues from its mistakes?
4. If we can’t agree on payment reform around infections and never events, we’ll never be able to agree on any change.
On balance, this is a slam-dunk and CMS has done the right thing.
Caveat: my favorite definition of quality — doing the right thing and doing it right. CMS is doing the right thing — the jury’s still out on whether they’re doing it right.
John McDonough
Beware of unintended consequences. When I operate on a diabetic patient and they do get mediastinitis redo surgery is usually needed. A plastic surgeon and an anesthesiologist are often involved to deal with this complex problem and move a muscle flap into the area of the necrotic infected sternum. So how am I supposed to get these physicians involved if medicare “won’t pay”? Am I the original surgeon now at financial risk for this unfortunate problem? If so, I and many other surgeons may cease to offer complex risky surgery to these patients. Then what?
Dr. McConnell,
Sir, I understand your confusion, those of us who deliver care think that the patient should be the central issue. However, we are clearly misguided, it is all about the money. Those who require complicated and risky procedures should receive no care, as this might cost an insurer some cash. The young and healthy, who require no care can have as much nothing as they need.