Comments on: CMS Offering Us Some Rope

By: ?

Sat, 15 Dec 2012 21:15:57 +0000

It is easy to say “its all subjective” but we do objectively assess.

By: WhiteCoat

WhiteCoat — Sat, 15 Dec 2012 02:51:42 +0000

Everyone wants positive outcomes, but a fact of life is that everyone also dies. So when there is a bad outcome, is there a doctor to blame in every instance? If not, how do you differentiate? The government certainly isn’t going to engage in an in-depth inquiry into every patient death.
You *believe* that there is a measurable difference for sicker patients, but try to quantify it. Some people may say “measure the APACHE II scores of patients” but I have never seen “quality” indicators that take APACHE scores into consideration.

CMS wants to use “speed” as a quality indicator. Do you think that fast docs have higher quality than slow ones? Or do faster docs blow off complaints, fail to take adequate history, perform cursory exams, and miss pertinent clinical findings? If you don’t know how medicine works behind the curtain and you only look at the “quality” indicators without knowing what those indicators represent, you’re going to be misinformed … at best.

By: ?

Fri, 14 Dec 2012 21:30:00 +0000

If people have negative health outcomes, is that indicative something needs to change? I know that I want positive health outcomes and I would expect both doctors and patients would as well. If a surgeon tries to save a critically ill patient, the outcome should account for the fact that the patient had a certain percentage of likelihood of certain outcomes and evaluate how the surgeon’s actions increase or decrease the likelihood of those positive/negative outcomes. So there is a measurable difference.

By: WhiteCoat

WhiteCoat — Fri, 14 Dec 2012 17:56:24 +0000

Not necessarily soliciting comments, but throwing out the concept that I believe we will only create further problems and more barriers to care by engaging in this “quality” rating process. See above.
When I make these comments, though, I like hearing feedback and engaging in the discussions, so if you disagree, I’d enjoy having a rational discussion about our differences in opinion.

By: WhiteCoat

WhiteCoat — Fri, 14 Dec 2012 17:54:05 +0000

You suggest that “outcomes” may be indicitave of quality. If a surgeon tries to save a critically ill patient and the patient dies, then is the surgeon not a “quality” surgeon?
That’s just the point. There’s no way to reliably measure “quality” in any venture.
It’s like trying to say that leather seats and good gas mileage are good metrics for a “quality” car or balanced budget and 90% happy constituents for a “quality” government.
If we suddenly made good outcomes a substitute for “quality,” then it would create an incentive for doctors to avoid treating severely ill patients for fear of being labeled as providing poor “quality” care when patients died.
By making all the suggestions about what metrics we *think* measure quality, we invite the government to focus on those metrics only while “quality” continues to decline.
Then we get what we ask for and have to live with our decisions while the government cuts payments to those who don’t perform well on these irrelevant metrics.

By: ?

Thu, 13 Dec 2012 08:57:30 +0000

Whitecoat: by posting this, were you looking for responses or suggestions for the Federal Register’s survey design? Were you looking suggestions for items for the survey? Are you looking for how the patient makes decisions on going to EDs or elsewhere?

By: Re

Re — Thu, 13 Dec 2012 08:40:31 +0000

What outcomes would be better measurements instead?

By: Don

Don — Wed, 12 Dec 2012 16:08:47 +0000

Except for the military and VA (for ex-military), we really don’t have any Government owned medical facilities in the US

I believe that most of the US Hospitals are not “for-profit” institutions either. They are nominally “not-for-profit” institutions. It doesn’t seem to restrict the amount of money the administrators make, but that is another issue.

If we were to try and switch to a public/private mix, like is available in some countries, we would basically be starting from scratch. Either the Government would be forced to cough up the money to buy many of the hospitals, or build new hospitals in direct competition with the existing ones.

It would probably greatly expand the size of the Public Health Service to administrate it.

By: Pär Areskoug

Pär Areskoug — Mon, 10 Dec 2012 19:57:00 +0000

Is there any debate at all on whether your system of private hospitals earning money of peoples illness is the right thing for the future? The United States spend the highest amount of money on healthcare per capita in the world, but do you have the healthiest population? I´m guessing this is a debate that’s well known for you guys, but for me (a medical student in my last semester in Sweden) it just seem insane.

Why not look at other systems with a more effective care, like the Swedish for instance. Is government-owned hospitals really such a far fetched idea?