Gaming the System
The perpetual nonsense of gaming the system continues. Here is something from the Wall Street Journal a little while back:
Long-term-care hospitals discharge a disproportionately large share of Medicare patients during a window when they stand to make the most money from reimbursements under the federal program, according to a study in the journal Health Affairs.
How coincidental? That is how human greed works. The author of the study said “Those look like decisions that are not driven by patient need or what is in the best interest of the patient”. Duh, ya think?
This is why I have been against quality metrics. If you take a family doctor, for example, and “pay-for-performance” him on 10 out of 100 types of medical problems he deals with then guess which ones he MOSTLY pays attention to? Forget the suicidal thoughts in the 55 year old with diabetes whose wife left him. No, you want to get his hemoglobin A1C down so you give him more meds.
Gaming the system is easy. It’s just not right.
The comparison I use with patients is that quality metrics is essentially No Child Left Behind for medicine. When you are judged or paid based on certain tests then you teach/practice to the tests.
We all know that much of medical practice can’t be measured or boiled down to an algorithm. However since the government can only judge you based on things they can measure, the measurables will receive an undeserved amount of attention as compared to the things that can’t be measured.