One more study showing Pay for Performance (the Administration’s only real suggestion for controlling costs) doesn’t work. (Gated but with abstract.)
Two-thirds of Americans take dietary supplements, but what’s in them? They cause 9% of liver injuries.
Can a stomach staple affect the obesity of your future children? Apparently, yes.
Some really neat weather photos. (The subjects could be hazardous to your health.)
Some other neat photos. (Non-hazardous.)
Not necessarily. As we have observed often at this site, pay-for-performance begins with the claim that we should pay more for better outcomes and after sleight-of-the-hand often ends by paying more, not for better outcomes, but for someone's notion of what the correct inputs should be. The latest depressing example is in the field of bariatric surgery ( e.g., stomach staples ):
The notion of designating bariatric surgery centers of excellence was promoted by the Centers for Medicare and Medicaid Services in 2006. The American College of Surgeons and the American Society for Metabolic and Bariatric Surgery established guidelines to designate them.
[However,] patients undergoing bariatric surgery have similar outcomes whether the operation occurs at a so-called "center of excellence" or in a regular hospital, researchers found.
The researchers said the findings show that the government's minimum volume for designation as a center of excellence — 125 operations per year — "does not necessarily result in better outcomes and that the minimum volume requirement is not evidenced-based."
Some drug companies are negotiating discounts and rebates based how well patients do, rather than on volume:
Merck has agreed to peg what the insurer Cigna pays for the diabetes drugs Januvia and Janumet to how well Type 2 diabetes patients are able to control their blood sugar…… the two companies that jointly sell the osteoporosis drug Actonel agreed to reimburse the insurer Health Alliance for the costs of treating fractures suffered by patients taking that medicine.
On October 1, 2008, Medicare announced its first list of “never events.” A never event is something that Medicare believes should never happen and it refuses to pay hospitals when such events occur.
Some of the items on the original October 2008 never event list make sense – surgery on the wrong patient or the wrong body part is obviously inexcusable. So is leaving a surgical instrument in a patient.
Unfortunately the list has expanded to include relatively unlikely but routine complications with the result that Medicare’s “never events” policy has the potential to skew clinical decision making in a way that does grave harm to patients.
Public employees earned benefits worth an average of $13.38 an hour in December 2008, the latest available data, the Bureau of Labor Statistics (BLS) says. Private-sector workers got $7.98 an hour….. Overall, total compensation for state and local workers was $39.25 an hour – $11.90 more than in private business.
And they may not have to perform:
House Democrats are now pushing to freeze pay for performance across the entire federal government…… Barack Obama said he would consider an overhaul or "complete repeal" of the merit pay system. If he follows through, the government's new CEO will soon learn that you get what you pay for.
Here are two doctors writing about Medicare pay-for-performance guidelines:
Since 2003, the federal government has piloted Medicare projects at more than 260 hospitals to reward physicians and institutions that meet quality metrics…..
One key quality measure in the ICU became the level of blood sugar in critically ill patients….. A colleague who works in an ICU in a medical center in our state told us how his care of the critically ill is closely monitored. If his patients have blood sugars that rise above the metric, he must attend what he calls "re-education sessions" where he is pointedly lectured on the need to adhere to the rule. If he does not strictly comply, his hospital will be downgraded on its quality rating and risks financial loss. His status on the faculty is also at risk should he be seen as delivering low-quality care.
But this coercive approach was turned on its head last month when the New England Journal of Medicine published a randomized study….. Half of the patients received insulin to tightly maintain their sugar in the normal range, and the other half were on a more flexible protocol, allowing higher sugar levels. More patients died in the tightly regulated group than those cared for with the flexible protocol.
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In stark contrast to government-initiated, pay-for-performance initiatives that have proved sorely disappointing, Geisinger Health System in the middle of Pennsylvania's coal country is proving that supply-side health reforms actually work:
The health system devised a 90-day warranty on elective heart surgery, promising to get it right the first time, for a flat fee. If complications arise or the patient returns to the hospital, Geisinger bears the additional cost.
The venture has paid off. Heart patients have fared measurably better, and the health system has cut its bypass surgery costs by 15 percent. Today, Geisinger has extended the program to half a dozen other procedures, and initiatives…..
Standardizing bypass surgery has saved Geisinger money on ventilators, blood products and staff time. Readmissions, which can be more expensive than the original surgery, have fallen 44 percent, according to Geisinger's data.
According to the British newspaper, Guardian, the administrators at Mid Strafford NHS foundation were so obsessed with meeting the four-hour maximum waiting time admission target that patients were often quickly shuttled to unstaffed units used as ER patient "dumping grounds" without having their conditions adequately screened.
This is from American Health Line:
Pay-for-performance programs have failed to improve quality, according to a RAND study [gated, but with abstract]……. Researchers looked at a pay-for-performance program that started in 2003 and involves seven major California health plans and 225 physician groups that treat 6.2 million people….. A separate study [gated, but with abstract] in the Annals of Family Medicine……. found that doctors believed pay-for-performance programs interfered with the doctor-patient relationship.
A paper by Twila Brase, RN, PHN, president of the Minnesota-based Citizens Council on Health Care, and published by ALEC, explains the dangers of relying solely on “evidence based medicine” (EBM) to determine appropriate treatment for an individual patient. The problems are too long to list here, but they include:
