WhiteCoat

Hey CMS – Compare THIS

I’m away on a business trip and happened to read an article in the USA Today sitting outside my hotel room door that ticked me off. The feds spent $1.9 million in advertising to push their “Hospital Compare” web site. They want the public to compare different aspects of hospital care before deciding to go to the hospital. Another article on the topic from Yahoo is here.

Supposedly the ads are to further the Bush administration’s goal to “increase transparency” in the health care system.

Do the ads mention that the “quality” initiatives requiring that antibiotics be given within 4 hours of a pneumonia diagnosis actually “raises the risk of misdiagnosis and inappropriate use of antibiotics?” In other words, if doctors follow the initiatives, patients can potentially do worse.

Do the ads mention that another initiative requiring doctors to perform blood cultures before giving antibiotics has absolutely no effect on clinical outcome? Do they mention that this requirement increases the length of stay by 4.5 days and increases the cost of hospitalization by over $5000 when “false positive” cultures are obtained (which occurs almost as often as “true” positives)?

Of course not. They just pit one hospital against another – twisting the thumb screws to make one hospital look bad if it doesn’t adhere to some of these nonsensical quality measures.

I still can’t figure out why CMS and the Bush administration have they excluded all the VA and military hospitals from their “hospital compare” web site if they are sooooo into transparency. Try searching for Walter Reed Army Medical Center or Tripler Army Medical Center on the site. Plug in the name of any of the VA hospitals in your area. Magically, according to the Hospital Compare database, government-run hospitals don’t exist.

OK, CMS … you want other hospitals to shape up? Get your own house in order first. Put that $1.9 million to a better cause – like taking care of the soldiers who have sacrificed their lives and their health supporting this country’s initiatives instead of leaving them “stranded in unfit conditions,” “neglected,” and “waiting four months for the results of important medical tests”. Video testimony about the conditions in Walter Reed Hospital can be found here.

“Do as I say and not as I do” doesn’t cut it. When you get the conditions at your hospitals in the top 10%, send me an e-mail.

I won’t hold my breath.

7 Responses to “Hey CMS – Compare THIS”

  1. hashmd says:

    Just the typical way to withhold money from providers. Who is dictating the “performance” measures? Not the doctors or hospitals in the trenches. With Medicare dollars, it is CMS. With commercial insurance, it is the insurers themselves and their own hired MD administrators who keep proposing new performance measures which are unlikely to be attained.

    Here in CA they proposed that wait times to appointments be included in the performance measures. With the current low reimbursements, I as an established physician cannot get a cold or flu patient into the office in less than a day. Because of overbooking, patients have to wait up to 1 1/2 hrs to see me. Why do I overbook? Because the profit margin is so thin I have to see more patients in a limited time (to avoid overtime for my staff). There is no way around that financial reality. Period.

    It would be the same if CMS set the new standard wait times for ER to be less than one hour! Based upon what evidence does that “quality standard” exist? None. It is just an arbitrary frame to make them look good, make 90% of the hospitals miss their targets and get paid less. CMS becomes the good guy and we in the trenches are the bad guys.

  2. Rogue Medic says:

    “Do the ads mention that the ‘quality’ initiatives requiring that antibiotics be given within 4 hours of a pneumonia diagnosis actually ‘raises the risk of misdiagnosis and inappropriate use of antibiotics?’ In other words, if doctors follow the initiatives, patients can potentially do worse.”

    Not just the patients being seen, but those who although healthy now, may be infected with multi-drug resistant bacteria in the future. Why is the government trying to contribute to what may be a large scale disaster at some point, when they have almost never demonstrated an ability to manage large scale disasters?

  3. jvalways says:

    so, i am not the only person who usually gets pissed off after seeing “usa today” headlines.

  4. Nurse K says:

    To play devil’s advocate, those people who are using the VA or Walter Reed probably aren’t in the market to compare hospitals, so adding them to that website would be pointless and cost more money.

    Good point, but not necessarily so.
    There are many patients over 65 who are covered by Medicare and who come to our hospital for emergency services and procedures because they “wouldn’t be caught dead” at the VA.
    Besides, how is the government supposed to establish benchmarks?
    Lead by example, right?

  5. VA isn't what it used to be... says:

    As a clinician in the busiest VA in the country (and no, it’s NOT Walter Reid) I can assure you the care is as good, if not better than many non-VA facilities. While I can’t speak for the ER directly as I have not read that data; a number of studies have been published comparing VA care to that of the outside world; we consistently outperform in Ambulatory care.

    http://content.nejm.org/cgi/content/short/348/22/2218

    Interesting.
    I know an “n=1″ study doesn’t mean much, but my experiences with the two VA hospitals in my area is quite the opposite. You can only get in touch with docs from about 9:30 to 4:00 and that’s only after waiting on hold for 20 minutes. Patients have to wait a long time for non-scheduled appointments and even longer for specialty care. Many who are able choose to come to the emergency department for care because they believe the care is better and quicker.

    OK, now the study is “n=2.” Here’s another example of VA frustrations – 774 rings of a telephone before someone answers a doctor’s phone call.

  6. Marilyn says:

    I have three family members who have been treated in VA hospitals, they have received care as good as or better than I’ve gotten on the outside. My brother recently underwent cardiac bypass and had a top-notch Stanford cardiologist caring for him.

    I would agree with Nurse K, military hospitals don’t serve the public and there would be no point rating them FOR the public.

    I agree that military hospitals don’t serve the public. But by not publishing the data, are you saying that military personnel should receive a different level of care than non-military personnel? Why hide the data?
    If the care in these hospitals is so good, then it should be a benchmark to which non-military hospitals should aspire.
    On the other hand, if the care is not as good, then I have a problem with the government expecting more from civilian hospitals than it, with its vast resources, can deliver itself.
    Besides, just because civilians can’t go to military hospitals doesn’t mean that military personnel can’t go to civilian hospitals. Shouldn’t they have a right to choose?

  7. prereddy says:

    Actually, Dr. WhiteCoat, there are ample evidence that in terms of preventative care measures and overall care, VA medical centers FAR outstrip that of non-military hospital care. No, I don’t work for a VA, I actually work at a university hospital and every single one of our quality improvement “ideas” seem to be things that the VA system has pioneered. I think you’d be interested in a book by the longtime government-deriding Phillip Longman, “Best Care Anywhere”, talking specifically about the ways in which the VA is significantly better than hospitals outside the VA system. While I do not fully agree with the book’s final conclusions, the evidence he provides and the references he provides are very convincing of the VA’s general superiority. Despite expecting to write a book denouncing the VA system, Longman was won over by the evidence as he researched for his book and the points he makes and the information he provides are incredibly compelling. Sadly, the VA system remains crippled in terms of its reputation from an era of corruption and mismanagement that is now long over.

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