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Pay-for-Performance Attacks Hospitals - Shake Down or Fair Play

Posted Dec 04 2011 6:00am
This blog has tried to support the virtue of personal responsibility. If you smoke, don’t blame Joe Camel. If you surrender to Big Mac attacks, don’t go after Ronald McDonald. If you love donuts, and your girth is steadily expanding, is it really Krispy Kreme’s fault? And, if you suffer an adverse medical outcome, then…

Medicare aims to zoom in on hospitals, suffocating them with a variation of the absurd pay-for-performance charade that will soon torture practicing physicians. Of course, a little torture is okay, as our government contends, but pay-for-performance won’t increase medical quality, at least as it currently exists. It can be defended as a job creator as several new layers in the medical bureaucracy will be needed to collect and track medical data of questionable value.

Medical quality simply cannot be easily and reliably measured as one can do with a diamond, an athlete or a wine. Most professions resist being graded or claim that the grading scheme is a scheme. Teachers, for example, refute that testing kids is a fair means to measure their teaching performance. Conversely, any individual or profession who scores well on any quality review program will applaud the system’s worth and fairness. Shocking.

Under the government’s new program, hospitals could be financially responsible for the cost of medical care that a patient requires for up to 90 days after discharge. One can imagine why this provokes angst with hospital administrators. It’s easier to defend the government’s concept if a heart attack patient is discharged prematurely and is readmitted two days later with congestive heart failure. The case is harder to argue is a stroke patient falls at a rehab facility 2 months after discharge and needs to be hospitalized. There will be spirited arguments as to whether the post-discharge events were preventable by higher quality and better coordinated out-patient care. Paradoxically, it might influence hospitals to prolong discharges, which increases costs and the risks of various hospital adventures, including infections and C. difficile colitis.

Government lexicographers have concocted a new phrase, ‘Medicare spending per beneficiary’, which will be used to compare costs among hospitals caring for the same types of patients.

How much responsibility can fairly be assigned to hospitals for bad stuff that happens once patients are released? If a medical event occurs at the nursing home, for example, would this be the hospital’s fault or the nursing home’s? It will be fun to watch the two institutions, who both champion patient care, duke at out. Cash breeds competition.

One item is beyond dispute. It’s a lot easier to measure cost than medical quality. I fear that many of these quality initiatives are veiled attempts to save money, but are camouflaged as medical quality incentive programs.

The ironic flaw in all of this is the absence of any quality control over pay-for performance and its cousins who claim they can raise the medical quality bar. I wish there was a way that we could pay these guys depending upon their performance. The government would resist this as it would be a job killer when all of these newly hired bean-counting bureaucrats would lose their jobs.
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