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.


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] 

  1 comment for “Gaming the System

  1. Randy
    August 25, 2015 at 1:46 pm

    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.

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