Friday, October 10, 2008

"Never Events" and Medicare

Medicare (aka CMS or Centers for Medicare/Medicaid Services) has now implemented a policy of not paying for certain bad patient outcomes that they call "never events". These include certain kinds of bedsores, post-operative infections, etc.

It's being portrayed as a measure to ensure quality and reduce costs. But physician-blogger WhiteCoatRants predict it will lead to some nasty unintended consequences:
1. You'll get diagnosed with a lot more illnesses so that it is very difficult to determine what care is not for a "never event" and what care is for the "never event." Then when you have to stay in a hospital longer because of a "never event," the hospital can allege that the extended stay was really due to a problem that was not a never event. That will mean more testing, more procedures, and higher costs.

2. If you develop a "never event," you’ll be more likely to get transferred to another hospital. CMS won't pay for never events if they develop in a hospital, but they will pay for treatment if you present with a pre-existing never event. Hospitals will develop unwritten agreements that certain specialists at each other's facilities are better suited to treat a certain patient's "never event." More transfers mean more redundant testing, higher costs, and more complications from the testing.

3. Testing and diagnosis of never-event conditions will diminish where feasible. That bedsore isn't a Grade 3 - it's only Grade 2. CMS will pay for those.
He predicts that these measures won't actually control costs. Then the government will propose to "rescue" the failing system with a complete takeover:
Enter the knight in the shining armor -- the same government that put us into this mess. "Let's try universal healthcare/single payor," the knight says from atop his noble steed.

...Whichever way you look at it, healthcare as we know it is about to change for the worse.

We're screwed.
Although I hope he's wrong, I fear he's right. Hence, one important point that physicians and policy makers should keep in mind as this process unfolds over the next few years is to make sure that the blame for these unintended consequences is placed where it belongs -- on new government rules and regulations. If legislators recognize that skyrocketing costs are caused by the government, then they might do the right thing and repeal some bad laws. But if they are only told that the problem is "greedy" insurance companies or "greedy" physicians, then this will give them more reasons to press for full-bore socialized medicine.

We've already seen this in the recent $700 billion Wall Street bailout, where the "free market" was blamed for problems caused by government interference in the free market.

This must not happen to American medical care, otherwise we'll all pay a price (in both money and lives) that will make the current $700 billion seem like chump change in comparison.