Bill Frist's Health Care Frisk

In an op-ed in the Washingon Times, Senator Bill Frist (R, Tenn.) discussed a new health care bill which strives for interoperability of Electronic Medical Record (EMR) systems to permit secure communication of information between EMR systems while also monitoring the "quality" of health care delivered by today's hospitals and physicians and "rewarding them" accordingly. It seems the Pay for Performance (P4P) model is well on its way to becoming the law of the land:

"The legislation gives the government the responsibility for helping to set standards, establishes a federal structure to oversee federal health information technology efforts, removes barriers in outdated laws, and includes some modest support for new information technology infrastructure. In addition, it will begin monitoring the quality of care so we can reward doctors and hospitals that provide the best care."

I always get scared when the government mandates such "quality" guidelines, especially when they plan to provide a financial incentive for following the rubric. Certainly practices, hospitals, and physician groups that follow the "quality rubrics" imposed by the government by electronically ordering tests and performing rote computer-supplied documentation lock-step with these requirements will be the ones that survive in tomorrow's health care environment. But are we not removing the "art" of medicine in favor of "paint by numbers?" Will such massive guideline-following really improve the quality of care, or the quality of reimbursements? Are we not making yet another bureaucratic convention to serve, rather than serving the patient? And at what cost? Only time will tell.

But what happens to this model if medical errors should occur in the course of treatment? It now seems doctors are not so reliable at self-reporting errors - particularly when the error was a system-based problem and not that of the responsible provider. Will the fear of NOT receiving Frist's "quality" bribes added payments further disincent accurate reporting of errors? You bet.

Worse still for doctors, this documentation requirement will likely become another reason for Medicare to refuse payment for services rendered. I can see it now: "Oops, we didn't see documentation of the pneumovax being administered in the last 10 years on your chart, so we're not paying for last week's gall bladder resection on Mr.Smith," says the insurer. There go your times in accounts receivable. Or perhaps in a best-case scenario, "Sorry, doc, without such documentation we'll only pay 50% of your bill. Our database shows you're a poor-quality provider..." Good luck reversing that designation once you're labeled.

I agree with Frist that the inter-operability and transmissibility of medical records between institutions will improve health-related communication between facilities and will result in improved and more efficient patient care. This needs to happen. But anytime a financial incentive is tied to reimbursement, it welcomes manipulation of the system, especially when such manipulation can occur under the guise of "improved quality of patient care" whether by caregivers or by the government. This is yet another example of the further commoditization of medicine - making medicine a fast food enterprise - and is offered as if this is the only path we can take.

Sadly, it seems such "quality payoffs" will likely benefit everyone except the patient.

--Wes