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Here's an article discussing the implementation of two new Obamacare-associated policies.


http://reason.com/blog/2012/10/02/hooray-for-two-new-reforms...

As expected, these two "reforms" are more central planning. They penalize hospitals for readmissions within one month and reward hospitals for meeting certain quality metrics.


From my point of view as an experienced emergency physician, this is just more "red tape" which will complicate care and drive up costs. The penalties for readmissions will be difficult to enforce appropriately and will provide perverse incentives for the way care is delivered. The incentives to promote "quality of care," will focus on metrics rather than the overall care of the patient. Certain metrics will improve but most likely to the detriment of overall patient care. Focusing on certain metrics fails to account for how other variables are affected. It assumes that there is some fantasy world where health care providers have unlimited time and resources. It fails to acknowledge that time spent trying to meet certain metrics and documenting these efforts is time that could be spent on other more important tasks.

Predictably, these reforms will fail, as all other similar efforts have failed, due to one basic flaw. They are centered around pleasing a third party (government) rather than the most interested party - the customer/patient.

When will they learn? Probably never. In the meantime, my job gets harder and more costly - and patients suffer.


dave
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"I'm from the government, and I am here to help you." Ronald Reagan

Every govt effort seems to involve more red tape and bureaucracy. And I am sure practitioners find it frustrating.

Still finding ways to measure the quality of medical services and working to improve them is good practice. I thought the medical community already had internal methods to monitor aspects like surgeon performance or the adequacy of sterilization.

Why can't the medical community be self regulating in this regard too?

Why do they need an outside boost from govt or the insurance industry?
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Still finding ways to measure the quality of medical services and working to improve them is good practice. I thought the medical community already had internal methods to monitor aspects like surgeon performance or the adequacy of sterilization.

Why can't the medical community be self regulating in this regard too?

Why do they need an outside boost from govt or the insurance industry?


The medical community does self-regulate. But the best regulation is a free market with competition. Patients/consumers will choose the best option. This is far more efficient than trying to to optimize only specific measures. Health care providers focus on certain numbers rather than providing the best overall care. Some of these numbers can be good measures but only if considered within the framework of overall patient care.

Let's use an example. One measurement has been the time it takes to start antibiotics for pneumonia in the ER. The goal was set to start antibiotics within a certain number of hours. Unfortunately, this gives physicians incentives to start antibiotics unnecessarily in case somebody has an atypical presentation for pneumonia. Certain patients get a costly drug (which may kill them if they have a serious allergic reaction) which they may not even need. It also penalizes busy ER's where patients might have to wait before being seen (the clock starts ticking once the patient walks in the door). The health care providers might need to sacrifice more important care for a sicker patient in order to start antibiotics on somebody who may or may not need them.


dave
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This is not unlike the resistance to measuring the effectiveness of schools. The professionals prefer to use their own best judgement without interference, bureaucracy, and red tape. I can respect that, as long as they get the job done.

There has been great resistance to publishing outcomes data on local hospitals. Some have sicker patients than others. Some serve areas where poverty, inadequate nutrition and poor recovery care at home are major components.

OK, its a complex problem. But "nothing can be done" is not acceptable. Its an attitude that invites government to try.
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This is not unlike the resistance to measuring the effectiveness of schools. The professionals prefer to use their own best judgement without interference, bureaucracy, and red tape. I can respect that, as long as they get the job done.

Government, in the form of super-empowered public sector teacher unions, have blocked these efforts. Unleashing free market forces, through competition and choice, will solve this problem. Less government, as usual, is the answer.

There has been great resistance to publishing outcomes data on local hospitals. Some have sicker patients than others. Some serve areas where poverty, inadequate nutrition and poor recovery care at home are major components.

Measuring certain outcomes without considering the health of the patient population does provide an inaccurate picture. That's why it's better to allow greater competition and market forces to operate. Bureaucratic attempts to measure quality are vastly inferior to a few hundred million people measuring quality on a daily basis.

OK, its a complex problem. But "nothing can be done" is not acceptable. Its an attitude that invites government to try.

It is a complex problem. But the current situation is not an invitation for "government to try." Government has already "tried" in the health sector and created a grossly inefficient highly costly mess. It's time to give free people and free markets a chance. It's an invitation to try proven methods such as greater consumer freedom and control over their health care dollar and greater free market forces. There is no perfect solution and a decent society will want to provide a safety net for those who need it. But that doesn't mean government needs to be a nanny to everybody in society and literally cripple their ability to get good health care.

dave
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I am all for safer hospitals. MERSA is becoming prevalent throughout the country, mainly, in my opinion, due to neglect of health-care professionals. Mind you, I am not anti-doctor. My father was Assistant Director of the local VA hospital (administrative), and most of our friends were physicians. I know the burdens the health-care professional carry. However, I do believe there is a lack of safe care in many areas.

HOWEVER, I feel that the patient should be somewhat responsible for observation. Did the MD, RN, LPN, CNA wash their hands when entering my room? Did I ask what prescriptions are being administered and why? Did I ask why certain tests are being performed?

Donna (who is in total control of her health care....maybe that's why I am relatively healthy)
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greater competition and market forces

But Dave, on what basis does the consumer choose his health care?

Outcomes reports on hospitals and doctors is fundamental to making good choices. And they must come from an independent body.

Arguing that all such reports are flawed and hence useless or misleading leads to the situation where choices are made based on anecdotes (Uncle Harry had a hangnail treated there years ago and did OK.) Or glossy advertizing.

Or trust your doctor's advice (to recommend where he has financial incentives)? Believe what you read in the news? On TV? On the internet? Trust your insurance company to send you where it gets the best deal?

I don't think competition works very well in this regard.
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