2012 Potpourri XIX

An article in the New York Times points out how the complex Medicare reimbursement system tends to pop out a new problem in a different place when a current problem is addressed.  In this case the issue is payment for dialysis drugs, which were clearly being abusively used by a number of vendors.  This overuse carried health hazards for patients.  So the government began to bundle the drug payment into an episode reimbursement system, which appears to have created an incentive to use fewer drugs, even when they may benefit a patient.  And that is apparently resulting in more transfusions, which also harm patients’ health.  The folly of trusting government “experts” again revealed.   (NYTimes Article)

One cause of readmissions, according to studies published in the journal Health Care Management Science, may be that surgeons aiming for more revenue may be discharging patients too early and not doing adequate discharge planning.  The researchers found a correlation between how full a hospital was at the time of discharge and readmission rates, suggesting that to create space hospitals were sending patients home too soon.  Surgeons and hospitals are certainly revenue sensitive and patients discharged at the busiest time in a hospital were 50% more likely to be readmitted within three days.  Now those are readmissions worth penalizing.   (Readmission Article)

Researchers looking at why different hospitals have varying costs for treating the same condition conclude that hospitals which do lots of procedures have higher costs even when they don’t do procedures for a particular patient.  The case of heart failure was examined, and only patients who didn’t get a procedure were considered.  The primary factor associated with variation in cost appeared to be the general cardiovascular procedural intensity of a hospital.  This suggests that hospitals may develop a generally expensive culture or practice style that raises costs for all patients.   (Circ. Outcomes Study)

Yet more research showing how complex understanding hospital readmissions is.  Researchers presented data at the American Heart Association’s Outcomes conference on over one million patients which indicated that readmissions rates for heart failure vary widely and appear more linked to socioeconomic factors and availability of care than to hospital quality of care or to the patient’s health status.  If this is true, it is very unlikely that the CMS program of penalties for excess readmissions, or similar programs, will do anything to improve the quality of care.   (AHA Study)

Not only is the health reform law a mess, apparently the administration knows it is and is resorting to wildly hilarious methods to use government power to try to persuade people it is a great thing.  In its infinite wisdom, Congress and the White House decided that insurers should have to spend a certain amount of each premium dollar on “health care”, which will and has created many perverse incentives.  But in the final Minimum Loss Ratio Rule issued by HHS, comes this bon mot:  insurers who exceed the ratio and must pay rebates, must tell the recipients it is because of the wonderful law passed by our dear leader.  How Orwellian.   (MLR Rule)