Another Quality Metric Fail

A new study in JAMA Cardiology found that “as many as 10,000 heart failure patients could die prematurely each year because of misguided efforts that keep them out of the hospital to avoid the financial penalties attached to higher readmissions.”  This comes as no surprise to ANY of us who actually do the real work in healthcare.  We have been saying this for years but it never mattered to the insurers, the government or the administrators.  Once again, quality metrics fail.  In this study, people died but the hospital doesn’t care because they didn’t lose Medicare money.  It’s gross.  Here is the beautiful part: nothing will change until Medicare changes the penalty even though the hospitals now know it is WORSE for patients. That’s the beauty of unproven metrics.  It changes behavior for the wrong reasons and that behavior won’t change back until the incentive changes.

This is actually a great test.  How many hospitals, who claim they are patient-centered, will change their policy before the government does?  Those that don’t (which I expect to be 100%) will prove that really they are just money-centered.

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  3 comments for “Another Quality Metric Fail

  1. Perry
    November 26, 2017 at 9:30 am

    These kinds of metrics, plus ACOs and other “cost-saving” schemes thought up by the talking heads are devoid of ethics. Words like patient-centered and quality are code words for saving money at the expense of the poor patient and using doctors as the grunts to carry out these immoral policies. And what’s more discouraging is our medical associations for the most part seem to go along gladly until they realize what’s really happening. Kind of like cattle being led into a pen thinking they will be fed, only at the last realizing they are there to be slaughtered.

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    • Steve O'
      November 26, 2017 at 10:25 am

      Bravo! These kinds of metrics, plus ACOs and other “cost-saving” schemes thought up by the talking heads are devoid of ethics. Machines cannot have insight; therefore, they cannot have ethics. Here are some suggested general rules about machine medicine:

      * A collection of laws can be described as a thing, a machine. There is no requirement for actual moving gears and flashing lights.
      * When a collection of laws is put into place, with no recourse to mercy – which is an untranslateable human value – that collection is best called a machine.
      * When humans have agreed to preemptively accept the conclusions and actions of a machine, they lose their humanity and have surrendered their conscience to machine morality.
      * Machine morality states that systems and things cannot fail. Only humans can fail.
      * Quality measures and punishments for human failure abound in the machine. Questions about whether the machine itself is poorly constructed and harmful are not permitted.
      * If there is a human scapegoat, there must always be laws that show human failure and insist upon punishment.
      * The law does not account for experienced humans to legitimately point out failure of the machine. These humans are called terrorists, wreckers, enemies of the People.

      There are only two conceptions of human ethics and they are at opposite poles.
      One of them is Christian and humane, declares the individual to be sacrosanct and asserts that the rules of arithmetic are not to be applied to human units.
      The other starts from the basic principle that a collective aim justifies all means, and not only allows, but demands, that the individual should in every way be subordinated and sacrificed to the community which may dispose of it as an experimentation rabbit or a sacrificial lamb. The first conception could be called anti-vivisection morality, the second, vivisection morality.
      Whoever is burdened with power and responsibility finds out on the first occasion that he has to choose; and he is fatally driven to the second alternative.
      (Darkness at Noon, Arthur Koestler)
      The struggle for the soul of medicine has gone on for about 100 years. It is finished. The society is fatally driven to the second alternative. The medical world is full of opportunists who will implement vivisection morality in the one place in which it is most stunningly obvious to desecrate humanity – in human medical care.
      [O]ur medical associations for the most part seem to go along gladly until they realize what’s really happening. ?? They have known about this for years. They are part of proposing value systems that think of themselves as ranchers, not advocates. They deliver the product. You are the product.

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      • Perry
        November 26, 2017 at 6:29 pm

        You are the product.

        Yeah, this product has gone beyond its “sell-by date”.

        You are correct, the soul of medicine has been lost to the machine.

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