Admission Restrictions at the Veterans Affairs
The NY Times exposed something called “admission restrictions” at the VA and it’s not pretty. Why did this happen? Quality metrics. Yup, those nasty little mandates that make healthcare worse. Here is what the article said:
The denial appeared to be part of an attempt by members of the Roseburg Veterans Administration Medical Center to limit the number of patients it admitted to the hospital in an effort to lift its quality-of-care ratings.
Ahhh, the old Pay-for-performance scam. I talked about this in 2012 in this article and said:
“…nothing will stop the freight train of P4P/Quality Metrics because physicians are not in charge anymore. Evidence be damned.”
That was over five years ago and yet it continues. P4P and quality metrics make people do bad things. More from the article:
- Fewer patients meant fewer chances of bad outcomes and better scores for a ranking system that grades all veterans hospitals on a scale of one to five stars. In 2016, administrators began cherry-picking cases against the advice of doctors — turning away complicated patients and admitting only the lowest-risk ones in order to improve metrics, according to multiple interviews with doctors and nurses at the hospital and a review of documents.
- Those metrics helped determine both the Roseburg hospital’s rating and the leadership’s bonus checks. By denying veterans care, the ratings climbed rapidly from one star to two in 2016 and the director earned a bonus of $8,120.
There are more examples in the article and I suspect it is going on everywhere. I predicted this over a decade ago and yet people pretend that they never knew it could happen. I distinctly remember the conversation I had at a medical staff meeting where I was critical of quality metrics and the medical director stood up at yelled at me at the top of his lungs, “What’s wrong with quality?!?”. I explained to him that this would happen. He didn’t listen. He was an ass and so are these people at the VA for what they did to our veterans.
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The hospitals do JACO bidding and react to Medicare payment schemes- resulting in harm. Examples: Insulin Protocols on Type 2 Inpatient diabetics; over diagnosis of sepsis, obvious increase in inpatient “palliative care” consults resulting in DNR status without primary care physician involvement.
MACRA was the death knell of my participation in Medicare:
http://thedoctorsreport.net/2016/10/macra-is-not-smart-or-we-eat-our-own-dont-we-or-will-the-cannibals-please-rise/
Why is Evidence Based Policy not a national Hashtag?
That’s how centralized medical care rolls.