Thursday, January 22, 2009

More Trouble With Medicare "Never Events"

Dr. Kevin Pho discusses more problems and unintended consequences caused by the new Medicare "never event" rules in his January 15, 2009 OpEd in USA Today, "Medicare's Mistake". Here's an excerpt:
...Where Medicare goes wrong, however, is by extending the no-pay rules to include "reasonably preventable" complications. These currently include patient falls and hospital-acquired infections.

...When a hospitalized patient develops an infection, for instance, it can be difficult to determine whether the fault lies with the medical staff or with a predisposed condition. This is a crucial distinction because Medicare will punish the former scenario but pay in the latter.

Hospitals might be motivated to order tests, without clear medical symptoms, to show that any infection caught from within its walls was already pre-existing.

The American Medical Association shares this concern, saying that the aggressive expansion of no-pay events can "drive up costs by requiring more tests upon admission."

Furthermore, some institutions could decide not to admit or perform elective procedures on high-risk patients, particularly the elderly, out of fear of being denied payment for complications it cannot prevent.

Robert Wachter, professor of medicine at the University of California-San Francisco and an authority on hospital medicine and patient safety, cautions that the rapid expansion of the no-pay idea looks like a "cost-cutting effort clothed in the garb of patient safety" that is "nowhere near ready for prime time."
In other words, government controls to save money will end up costing more money in the long run, because doctors and hospitals will practice to suit the external incentives created by regulation rather than according to what's in the patients' genuine medical interests.

These sorts of unintended consequences will become the norm if we adopt any form of government-run universal health care.