Saturday, June 23, 2007

Proving Our Worth

I just don’t get it.

Here’s how we attempt to control the costs of healthcare in America.

First, we must prove to the medical consumer that we have good healthcare in the US and that Medicare is getting their money’s worth, so we assemble TONS of people in the form of associations including: the American Hospital Association (AHA), Federation of American Hospitals (FAH), Association of American Medical Colleges (AAMC), Centers for Medicare and Medicaid Services (CMS), the Joint Commission, the American Medical Association, the American Nurses Association, the National Association of Children’s Hospitals and Related Organizations, American Association of Retired People, American Federation of Labor and Council of Industrial Organizations, the Consumer-Purchaser Disclosure Project, the Agency for Healthcare Research and Quality, the National Quality Forum, the Blue Cross and Blue Shield Association, the National Business Coalition on Health, General Electric, and the U.S. Chamber of Commerce.

Next, we give them a nice marketing name like the “Hospital Quality Alliance.”

Then, they then make sure the hospitals and care providers know the “74 answers” to the tests that they’ll be tested on.

Next, they collect scads of information on every patient admitted to nearly 5000 hospitals across the country.

They spend countless hours of personnel time, intellectual energy, and human resources.

Then they crunch the data.

They spit this data out on a website paid for by the consumer by tax dollars on yet another government department database owned by the Department of Health and Human Services.

And when they reviewed heart disease care statistics, they only find that 17 centers (0.4%) provided exceptional care and 35 (0.8%) provided “substandard” care. Gratefully, they can now justify to those lackluster performers that they will withhold some of their Medicare reimbursements to them and save the government (and taxpayers) a bit of money.

After all, 99.2% of hospitals, they found, are doing a “good” job (at least when it comes to heart disease) by upholding their measures of “good” care.

So what have we learned?

We have now learned that there are millions and millions and millions of dollars of health care and association resources being expended to collect data that might mean something to 0.8% of the hospitals in America and to a tiny fraction of the medical consumers out there.

And will these data really effect care outcomes? For instance, should the ambulance carrying a person with chest pain bypass a hospital with a poor door-to-balloon time in favor of one that meets the standard? Or might this delay care further? Who will decide?

The real outcome question I’d pose is this: Is all of this retrospective review of health care delivery in America worth its cost to gather and process the data when we find it changes how only 0.8% of the hospitals in America will be reimbursed?

Or might our time, energy, and efforts be better expended improving health care facilities, providing programs for the poor, and taking care of patients?

But then, think of all the administrators who might become unemployed, eh?



jmb said...

And now their funding has been cut these sub-standard facilities will no doubt provide even more sub-standard care. Also was the sub-standard care in the first place due to insufficient funding?
The mind boggles at bureaucratic thinking.

Jaz said...

You - perhaps accidentally - are confusing the recent 30-day mortality rates data with the larger collection of process measures. Could you please document your assertion that hospitals falling in the "worse than expected" on one of the two 30-day mortality rates are subject to any change in any funding?

The only change I'm aware of is each hospital being given direct root cause analysis and quality improvement support - which does in fact cost *more* money, more dollars sent, albeit a little indirectly, to improving those hospitals' care.

(I'm not saying the two mortality rates stand alone as awesome examples of quality measurement, but they're a very small, and very new part of the bigger picture you draw in your original post.)

DrWes said...


Thanks for your comments. I am referring to CMS's Pay for Performance initiative. If hospitals don't "perform," their reimbursements are docked.