A Good Goosing

Pretty soon Medicare will reduce payments by up to 1% for more than 2,200 hospitals for excess readmissions in three categories — heart attack, heart failure and pneumonia.  This makes up about two-thirds of U.S. facilities!  They will lose about $300 million next year and maybe more the year after if they don’t improve.   Are most of our hospitals in this country that bad?  No.  This is just an unproven metric that the government is using to save money on healthcare.  My favorite part of this American Medical News article  was Nancy Foster, AHA’s vice president of quality and patient safety policy, who pointed out the following:

  • Hospitals had argued that penalties should be assessed only for aspects they can control.
  • The American Hospital Assn. and the Assn. of American Medical Colleges had asked CMS to consider socioeconomic factors that can lead to patients being readmitted.
  • Facilities had suggested that rates be adjusted to account for numbers of Medicaid beneficiaries as well as for planned or unrelated readmissions.
  • Other factors that need to be considered include patient access to follow-up health care services, such as availability of primary care physicians and ability to afford prescribed medicines.

Why is that interesting to me?  Well, all these points are certainly valid, that’s for sure, but how many of these 2200 hospitals that are getting dinged employ physicians?  I bet most if not all of them.   And how many of these hospitals are using their own unproven quality indicators to grade and penalize their employed physicians in such areas as cholesterol, glycohemoglobins, blood pressures?  Probably most of them.  And their doctors are arguing that these “penalties should be assessed only for aspects they can control”.  And the douchebag hospital administrators ignore them.  Because to them, what is good for the goose is not good for the gander.

Douglas Farrago MD

Douglas Farrago MD is a full-time practicing family doc in Forest, Va. He started Forest Direct Primary Care where he takes no insurance and bills patients a monthly fee. He is board certified in the specialty of Family Practice. He is the inventor of a product called the Knee Saver which is currently in the Baseball Hall of Fame. The Knee Saver and its knock-offs are worn by many major league baseball catchers. He is also the inventor of the CryoHelmet used by athletes for head injuries as well as migraine sufferers. Dr. Farrago is the author of four books, two of which are the top two most popular DPC books. From 2001 – 2011, Dr. Farrago was the editor and creator of the Placebo Journal which ran for 10 full years. Described as the Mad Magazine for doctors, he and the Placebo Journal were featured in the Washington Post, US News and World Report, the AP, and the NY Times. Dr. Farrago is also the editor of the blog Authentic Medicine which was born out of concern about where the direction of healthcare is heading and the belief that the wrong people are in charge. This blog has been going daily for more than 15 years Article about Dr. Farrago in Doximity Email Dr. Farrago – [email protected] 

  4 comments for “A Good Goosing

  1. Bridget Reidy
    September 1, 2012 at 4:18 pm

    Can’t say I disagree with the readmission penalty. If it could get a hospital to realize that outpatient care matters, they might even send me a good old fashioned discharge summary, or keep the fax I sent them about how my pt coming in is at baseline and in need of someone to support, not contradict, the end of life counseling I have provided.
    Bridget Reidy MD

  2. August 29, 2012 at 2:08 pm

    I fully agree that the metrics being applied are entirely spurious. However, they are metrics developed by administrators FOR administrators, and it’s hard to get administrators to accept metrics which detail real-life conditions. They don’t LIVE in the Real World.

    If there is any way to get the health corporations to lay off 2/3 of their administrators AND the governmental agencies to lay off an appropriate amount of bureaucrats, what would happen? Well, the unemployment statistics would rise… as would the quality of health care statistics. I’m sure any politician would see that as an unreasonable tradeoff.

  3. Kurt
    August 29, 2012 at 10:28 am

    The absolute big problem is dealing with non-compliant patients.
    That is the issue. Also people who have difficult terminal problems that get readmitted due to their condition and not “their” or their doctors faults. End-stage CHF? Tough. Maybe Obama should bring back his “death panels”. Use too many resources and you’ll be put on a DNR, “do not hospitalize” list. Yeah, that would go OVER real big.
    I’ve had smokers who taxed the system royally. Keep smoking, refuse efforts to quit and don’t give a shit. Sooooooo, punish the hospital and the doctor who cares for them?
    You will be seeing more and more Drs. who refuse these types of people as regular patients. Oh what the hell, they’ll be seeing a different hospitalist each time so big deal!

  4. Kathy
    August 29, 2012 at 9:16 am

    My view on this has shifted. I work with hospitals, LTC and physician groups as a risk management consultant, so I have my nose in their problems and issues all day. Either through ownership or discharge planning, hospitals have a lot more influence than they think. By helping patients (who don’t have medical background) and subsequent providers (who often get little guidance on a patient’s underlying conditions) to understand the complexities of a patient’s situation, hospitals can make a substantial difference. LTC and rehab own part of this too, and the great facilities that I visit are doing their own readmission studies and identifying ways they can pro-actively address bounce-backs. Now that hospitals have a reason to care, they should be partnering with those great rehab facilities to get their patients into an environment that minimizes future issues.

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