The Quality of Force by Pat Conrad MD


The 6/1/14 issue of Family Practice News had an innocuous article in the the practice economics section: “Readmissions dropped by 8% from 2011 to 2012.” The author states that the “real dent in hospital readmission rate [was] according to government data.”

– 30-day all-cause Medicare readmissions were 17.5% in 2013, vice 18.5% in 2012, as released by the Agency for Healthcare Research & Quality.

If I haven’t put you to sleep yet, congratulations, because here is where it gets funny:

“Federal officials credited the Affordable Care Act with providing the tools hospitals needed to make improvements, including one that ties hospital payments to reductions in readmission rates.” Translation: our government masters decided not to pay for any additional work done, implying a presumption that the job was not done properly the first time. I had my house painted last spring by, as it turned out, a lousy con man who did a poor quality, incomplete job. And no, I didn’t pay him the balance owed until he actually finished the work, so I understand the concept. But every non-government physician knows that a comprehensively addressed, perfectly treated, good-outcome elderly patient admission can be undone a week later by a fall or a UTI that had noting whatsoever to do with the previous ailment.

Starting this October “The Medicare Readmissions Reduction Program…imposes payment penalties that will rise to 3% and will be based on readmissions for acute myocardial infarction, heart failure, pneumonia, COPD, and hip/knee arthroplasty.” Because no cardiac patient with COPD is ever at risk for a DVT or pneumonia following a knee replacement.

HHS claims that hospital-acquired conditions decreased 9% from 2010 – 2012, resulting in 15,000 fewer deaths and $3.2 billion saved. Cynics like yours truly will suspect that a lot of these now forbidden complications were simply not reported or hidden within other diagnoses, and that these savings are more extrapolated myth than fact.

Dr. Patrick Conway, the chief medical officer and director for Center for Clinical Standards and Quality at CMS – whew – “credited hospitalists for their role in achieving “dramatic progress.””

“We’ve removed almost half of the measures that were in hospital value-based purchasing …because the performance has increased so much.” But what has that “performance” really been? It means that hospitals and their physicians have treated their patients not necessarily according to their best judgment, but in keeping with CMS dictates. I’m sure Dr. Conway is a very nice gentleman in his private life, and I could not care less – in public he is a government drone, taxpayer-fed, without ever having to see patients, fill out damn codes and modifiers, or risk lawsuit and burnout. His job, competently done, is to spout unproven gibberish about quality and savings as compliments, when these are merely justifications to refuse payment to those who do the work.

What Dr. Conway and his overlord parasites cannot, and will never admit is that their “Readmissions Reduction Program” is force applied by those who don’t treat patients, against those who do. It is a scam whose only achievement has been to alter the way doctors and hospitals try to game the system to survive.

If this were as simple as house painting and the pay scales similar, then I’d probably opt for the fresh air and more provable quality measures.


57230cookie-checkThe Quality of Force by Pat Conrad MD