Tuesday, November 17, 2009

Sebelius: Talking the Talk or Walking the Walk?

Here's a bit of the transcript from Kathleen Sebelius, Department of Health and Human Services Secretary, speaking to the Wall Street Journal's CEO Council (approximately 2 min, 45 sec into video) about saving health care costs:
... There are lots of features of the House Bill and that are already in the Senate bill that change that (the way doctors are paid). We are beginning to move away, particularly in Medicare, from traditional fee-for-service pay that I would suggest not only causes redundancy but doesn’t encourage innovative, high quality, low cost practices to moving toward a system that exists in pockets, exists in Mayos, Geisinger, (Inter-)Mountain Health Care. We know what it looks like. It isn’t how medicine is practiced it isn’t the the hospitals and providers are paid, so "bundled payments," "medical care homes," "accountable care organizations" – all buzzwords for really providing financial incentives and eventually financial penalties for appropriate medical protocols and appropriate outcomes - stopping the system now where one out of every five who’s released from the hospital is back in 30 days having never seen a health care provider, reducing or eliminating hospital-based infections, which are now one of the top 10 leading causes of death in America. We know exactly the system that can be done to stop it. It doesn’t take any capital investment It doesn’t require any new technology.”
I wonder what she means by "... eventually financial penalties for appropriate medical protocols and appropriate outcomes?"

Why penalize people for adhering to appropriate medical protocols? Or maybe she just needs some sleep...

And then there's this quick fact check:

Septicemia: #10 in 2006 (1.3% of deaths) CDC list for death in America and was #11 in 2004 (1.4%) but is substantially better than rates in 1997 (2.4% of deaths).

(Just keeping it real.)



Anonymous said...

Not every case of sepsis is iatrogenic...
Stay home, don't come to the hospital at all to avoid infections, is that ObamaCare's solution?
Do they propose that all MDs are on staff and paid by a facility? They appear to have no clue how health care really functions.

Anonymous said...

Dr Wes,

Re Sebelius quote about penalties... Don't you think it may be nothing more than a case of poor sentence construction and she really doesn't intend to penalize appropriate protocals. That "penalize" stuff just got garbled into the wrong place in that sentence. Happens to all of us. Think of Biden, think of Bush, think of Palin.

Anonymous said...

Dr. Wes,

I'm just a layperson but I'll confess that that ranking of infection as a cause of death was pretty shocking - even if it was way back in 2006. I'm sure glad you can assure me that those stats are improving, especially since I'm soon to have some pretty heavy duty surgery that's going to keep me in the hospital for more than a week. Hope I don't annoy my doctor and other med staff too much if I ask if they have washed their hands before fiddling with all the tubes that will be attached to various openings - some new, some original - in my body.

DrWes said...

Anony 02:04 -

I understand the challenges with speaking publically - hence why I suggested Ms. Sebelius consider more sleep, rather than to suggest "she lied!" (pun intended)

But I think we should also call out this liberal sound bite that "hospital-based infections" are one of the reasons government won't pay doctors and hospitals. As CardioNP points out, septesemia (the "#10" cause of death) is not synonymous with doctor and hospital personnel providing "poor quality care" (one only has to think of immunocompromized patients to understand this).

The perpetuation of ths political sound bite suggests our health care system is unconcerned with these infections and undermines the very real efforts of those who have worked tirelessly to limit them.

No, instead we want to limit people's pay by any means possible.

That is really what this is all about.

Michael Kirsch, M.D. said...

I expect that Sebelius & Co. will soon declare that every adverse medical outcome and complication are now 'never events'. Then, every patient will achieve the perfect medical outcome they deserve. www.MDWhistleblower.blogspot.com

Anonymous said...

Point absolutely given that medical staffs are working very hard to limit infections (Pronovost checklist - I've done a little research) And I won't object to you calling out this "liberal sound bite". How about working on the damn "death panel" sound bite? I assure you that I don't want to reduce your pay. For all of my life I haven't needed any specialists. Now I need them big time. The three I have met have been stupendous and I wish they were MUCH better compensated by Medicare and my supplemental. But I also think all our citizens should receive medical care. When they figure out a way to do both, I'll be grateful. But just saying "No" is not the way to go.

Michael Kirsch, M.D. said...

Where's the hope for comparative effectiveness research if our own government (Sebelius) trashes it's own agency (USPSTF)? We learned a lot last week, but nothing that creates optimism for meaningful reform. Why does new mammography guidelines start a crusade? When my colonoscopy guidelines are revised, there's barely a hiccough. See http://bit.ly/656CwP