Preventable Admissions is a Stupid Metric


Looks like there is some more trouble in Qualityland:

A new national study looked at preventable hospital readmissions at 43 free-standing children’s hospitals. The analysis showed that some facilities face payment penalties not necessarily because they provide poor quality care, but because their patient populations experience many hardships.

Once again we see how stupid it is to pay doctors and hospitals for issues that are out of their control. As this article states, “excessive readmissions can be explained by a patient’s inability to afford medications after being discharged from the hospital or because they can’t find transportation for a follow-up medical visit.”

I hope the readers of this blog are starting to agree how this quality fad is bogus but it may not matter.  The payment reform train is full steam ahead and these hospitals, in poor areas, are going to get destroyed.  How sad is that?  Instead of paying money to get better nurses and doctors in these hospitals, we now pay that money to an excessive number of administrators who just bean count, go to worthless meetings, eat bagels, drink coffee and dream up worthless things for these nurses and doctors to do.


So what is the answer?  Well, the idiots, who created this problem in the first place, have come to the rescue.  Here is what Dr. Helen Burstin, chief scientific officer for the National Quality Forum in Washington, D.C., came up with:

  • One proposal would pay providers based on the progress they make at improving the health of their patients over time.
  • Another would pay them based on the performance of similarly-matched peer organizations.
  • “You might be able to look at hospital groupings by the proportion of poor patients they may have and only compare them to like hospitals that have the same proportion of poor patients.”

I don’t even know that she means with any of these proposals. That’s how stupid they are.  Willie Sutton was asked why he robbed banks and replied, “Because that is where the money is”.   How does this relate here?  Find where the money is going in these hospitals (administrators) and then plow it back into the staff.  No more Press Ganey scores.  No more PQRS.  Just pay for good doctors and good staff and make sure there is enough nurses. These are the people who truly care and will do a good job for patients. Without them, the hospital is just a building.


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] 

  10 comments for “Preventable Admissions is a Stupid Metric

  1. chris dobrose
    February 19, 2016 at 6:29 pm

    They should call this stuff “No Patient Left Behind”. This same asinine government thinking has led us to the current state of public education which can be summed up as constant pre-testing, test preparation and testing. Then once the test is administered all teaching activity stops because, well, its not on the test. I have a guaranteed way to stop re-admissions–kill the patients.

  2. EllieRN
    February 18, 2016 at 1:29 pm

    Readmissions are something that need monitoring. The cost of a single readmission is often more costly than the original admission. While some simply can’t be prevented, many can. In the example you cited, perhaps a more cost effective medication that treats the disease can be prescribed. The bottom line is fractured transitions of care likely contribute to the problem at hand. Comprehensive discharge planning and proper transitions of care that take into account all aspects of the patient must be evaluated. This is where care coordination is of benefit to our healthcare system. Telehealth is another proven method to improve readmissions and patient outcomes.

    The United States Healthcare system is one of the costliest systems in the industrialized world. We lag far behind in outcomes. If we don’t have metrics to improve outcomes and contain costs, our healthcare will suffer as costs continue to escalate.

    • Doug Farrago
      February 19, 2016 at 6:33 am

      I am all for systems improvement. We should always want to get better but using these metrics to pay hospitals and doctors is stupid. You are brainwashed by the dogma that this crap is needed. We are a costly system, thanks to administrators and insurers, but our outcomes are fine.

  3. Chloe
    February 18, 2016 at 11:56 am

    Here is a revolutionary idea — When a doctor treats a patient, pay her for that treatment. When a patient is admitted to the hospital, pay the hospital for that admission. Kinda like wjhen your plumbing needs fixing, you pay the plumber, you don’t pay the plumber a flat fee based on how well your plumbing continues to work. I mean maybe you have cheap plastic plumbing and the guy down the street has really good copper plumbing, or ,maybe you abuse your plumbing by flushing hot wheels down the toilet (yeah, it happened). I mean it’s not the plumber’s fault or responsibility. is it? So why don’t we just pay doctors for the actual work they do like everyone else (except administrators) gets paid ? Crazy talk, I know.

  4. Pat
    February 17, 2016 at 10:26 am

    “One proposal would pay providers based on the progress they make at improving the health of their patients over time.” Which by definition is not possible, because all patients’ decline over time, establishing a goal that can be defined such that it can never really be achieved.

  5. drPhil
    February 17, 2016 at 9:28 am


    Thunder bolt and lightning…

    You could nationalise the medical system (like the rest of the first world)?

  6. Seneca
    February 17, 2016 at 8:30 am

    As stated on this blog many times before, caring for patients is a dead end –the real action is in administration. The train of “quality” measurements with oversight of obviously incompetent physicians by quality seeking administrators or nurses (who can object to “quality”, right?) has long since left the station and is picking up steam. From today’s Wash Post:

    Options for physicians on the over 50 side of their careers:

    Bend over and take it


    Go DPC

    Join the forces of evil and get an adminstrative job –although anyone who has not attended many hospital meetings has no idea how boring and redundant they are. Each nurse and flunkie from every logistical department wants to get a comment in to demonstrate their worth to the organization.

    I hope I can find a good PA/NP/other LELT to take care of me when I get old and sick; physicians will almost certainly be gone from primary care.

    • drhockey
      February 17, 2016 at 9:27 am

      I just read the Washington Post article. There seems to be no end to the administrative [email protected]$hit.

      Again, whenever I hear or read “high quality, cost effective,” my eyes glaze over and I have another petit mal seizure.

      I must get on medication for this!

  7. Steve O'
    February 17, 2016 at 8:23 am

    -On the payor side – Government and private – profit and financial reserves are increased by incompetence. The more incompetent the controlling organization, the less money spent. That’s how MediCal works, and they’re the pioneers for this Alice-in-Wonderland world.
    -Remember, if you don’t hospitalize for pediatric pneumonia in the first place, you can’t get a bounce-back readmission! We’ll have the clipboard gunslingers in the ER refusing admissions, thanks to the bounce-back policies.

  8. Perry
    February 17, 2016 at 7:19 am

    But you see, the point is to deny payment, not to pay, so these are perfect metrics for denying payment.

Comments are closed.