October 15th, 2009 by Happy Hospitalist in Better Health Network, Opinion
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Over at the WSJ Health Blog, some academic docs, such as hospitalist Dr. Wachter are suggesting just that.
Punishments such as revoking privileges for a chunk of time tend to be used for administrative infractions that cost the hospital money – things like failing to sign the discharge summaries that insurance companies require to pay the hospital bill. By contrast, hospital administrators may just shrug their shoulders when it comes to doctors who fail or refuse to follow rules like a “time out” before surgery to avoid operating on the wrong body part.
Docs and nurses who fail to follow rules about hand hygiene or patient handoffs should lose their privileges for a week, Pronovost and Wachter suggest. They recommend loss of privileges for two weeks for surgeons who who fail to perform a “time-out” before surgery or don’t mark the surgical site to prevent wrong-site surgery.
This couldn’t have come at a better time. At Happy’s hospital there is a massive witch hunt to crack down on not signing off verbal orders within 48 hours. This has nothing to do with patient safety. It has everything to do with meeting the requirements of CMS so the hospital does not lose their funding. Read more »
*This blog post was originally published at A Happy Hospitalist*
October 7th, 2009 by DrRob in Better Health Network, Health Policy, Opinion
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Dear Mr. Obama and all of you congress folks:
I know you have been arguing about how to fix our system (and it really does need fixing). I know there is not much you can all agree on. I know it wasn’t all that much fun to face those yelling people at the town hall meetings. The press hasn’t been nice, and the polls aren’t good either. You guys are having a rough go of it.
So I am going to do you a big favor.
What you need right now are some quick wins – some things you can do that will make people happy quickly, and things that can be done without much cost. This is low-hanging fruit that can be picked without a high ladder; it is fruit that will sweeten things and make swallowing the more bitter pills a little easier. Here is what you need to do first:
1. Allow Medicare Patients to Use Drug Discounts
Read more »
*This blog post was originally published at Musings of a Distractible Mind*
October 6th, 2009 by DrRich in Better Health Network, Health Policy, Opinion
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In his previous post, DrRich used a combination of history, logic, and sleight of hand to convince even his most conservative readers that healthcare is indeed a right.
To summarize that erudite posting: The BOSS rule says it’s a right, so it’s a right – as long as we’re talking about a civil (or legal) right, and not about a natural (or inalienable) right.
A civil right is granted, more or less arbitrarily, by a government or a society, to some group of individuals, usually to redress a past grievance, or to attempt to achieve equality in outcomes, or for some other form of social justice. Civil rights almost invariably require a second group of individuals to sacrifice something of their own in order to satisfy the civil rights granted to the first group. So the granting of civil rights (as opposed to natural rights) will often be seen by at least some as being inherently oppressive, but if used appropriately civil rights can be very good for the furtherance of a stable and civil society. (As DrRich has pointed out, even our Founders – the great purveyors of natural rights – explicitly understood the importance of well-designed civil rights.) Civil rights, at least ideally, advance the virtue of justice, just as their creators claim. Read more »
*This blog post was originally published at The Covert Rationing Blog*
September 30th, 2009 by DrWes in Better Health Network, Health Policy, Opinion
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It’s the holy grail of physician payment reform: ending fee-for-service payments to doctors and, instead, pay doctors based on the quality of care they perform. Remarkably, Congress feels they’ve found the answer:
Thus, the new language in the Senate Finance bill would finally connect Medicare reimbursements to quality, as opposed to volume.
The measure gives the secretary of Health and Human Services, working with the Centers for Medicare and Medicaid Services, the power to develop quality measurements and a payment structure that would be based on quality of care relative to the cost of care. The secretary would have to account for variables that include geographic variations, demographic characteristics of a region, and the baseline health status of a given provider’s Medicare beneficiaries.
The secretary would also be required to account for special conditions of providers in rural and underserved communities.
Additionally, the quality assessments would be done on a group-practice level, as opposed to a statewide level. Thus, the amendment would reward physicians who deliver quality health care even if they are in a relatively low quality region.
The secretary of Health and Human Services would begin to implement the new payment structure in 2015. By 2017, all physician payments would need to be based on quality.
Wow. That sounds great! But there’s just one problem…
… how do we define “quality?”
Read more »
*This blog post was originally published at Dr. Wes*
September 3rd, 2009 by Shadowfax in Better Health Network, Health Policy, True Stories, Uncategorized
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File this under utterly predictable:
Aetna tightens payment policies on hospital errors – Modern Healthcare (sub req)
Aetna has established new, tighter policies dictating when it will and will not reimburse for medical care related to errors made by providers.
Under the policies, Aetna has broken errors into two categories: “never events”—three events involving surgery: wrong patient, wrong site and wrong procedure—and 25 serious reportable events as defined by the National Quality Forum. Providers will not be reimbursed for a case involving one of the three never events, under the new payment policy. Of the 25 events, eight will be reviewed by Aetna to determine whether reimbursement should be withheld. The rest of the events will also be reviewed under Aetna’s new policy, but they will not be considered eligible for adjustments to reimbursement, the spokeswoman said.
This of course follows on the heels of Medicare’s decision not to pay for such events. The good news is that, as far as I can tell, Aetna has not extended the policy as far as Medicare has. Medicare, you may recall, also decided not to pay for certain (arguably) preventable conditions, such as foley-catheter-associated urinary tract infections, and surgical wound infections. Aetna, at least for the moment, is limiting its policy to the more black-and-white “never events” as defined by the National Quality Forum: items such as wrong-patient surgery or death due to contaminated medications.
I mention this not to rail against these standards or against the notion of incentivizing hospitals financially to avoid errors, but to highlight how rapidly and directly Medicare policies are aped by private insurers to the point that they become industry standards.
*This blog post was originally published at Movin' Meat*
