Summary
The items listed in this article sound wonderful, but offer limited promise to affect the healthcare industry. Puting rules in place to limit the amount of healthcare consumed without enacting malpractice reform and altering the demand of the public for healthcare will frustrate the goals of the National Priorities Partnership group. The answer to the problem of medical errors is not reducing payments to hospitals, but to make money available to hospital to increase staffing.
Analysis
Group offers fixes for health care system. This article claims that doctors and hospitals are on board with the initiatives listed for the recent National Priorities Partnership meeting. The goals of the partnership are ones few can argue with, they seem logical, desirable, and are initiatives that should have already been enacted by Medicare. The questions I have is, why have not these initiatives been enacted, and why do some of these items still exist even though Medicare has enacted rules to prevent them? Over the years, some of the brightest minds in the country have gathered to try and solve the healthcare price and access problems. President Regan initiated healthcare inpatient payment reform which was supposed to solve the price problem, but it did not. The Jackson Hole group used to meet annually and discuss healthcare issues, but they did not solve the problem. President Clinton’s administration tried to solve the problems, and they could not. One bright economist working on the Clinton healthcare reform proposal was quoted as saying, “you cannot sufficiently suspend the laws of economics to control both the healthcare price problem and the healthcare access problem at the same time.” This was a very candid public acknowledgement of the healthcare problem our country has wrestled with since before the enactment of title 18 and 19 of the social security act in 1964 (the Medicare and Medicaid programs). Prior to 1964, healthcare inflation was roughly the same as consumer price inflation, but the country had a healthcare access problem. After 1964, healthcare inflation has been close to double consumer price inflation, but healthcare access has been better. The healthcare problem is this, there is not enough money in our country, or any country, to pay for all the healthcare that the citizens of a country feel they are entitled to. Countries who have adopted socialized medicine programs have found this out and have resorted to rationing healthcare. The rationing of healthcare is done under the protection from malpractice suits (as long as the rationing conforms to the rules established by the government). Whatever rules a government puts in place cannot overcome or thwart the collective forces of demand for healthcare. The failed communist experiment showed government control of an industry does not work to allocate resources appropriately. Not paying for certain procedures will not change the public’s demand for those services. There are rules in place now governing approval of procedures for Medicare beneficiaries based on medical necessity. However, if a patient wants the procedure or the physician is worried about a malpractice suit, the physician will figure out a diagnosis code that will allow Medicare to pay for the test, keep the patient happy, and reduce his exposure to a malpractice suit. For instance, Medicare has a rule stating an EKG before a surgery is not medically necessary unless the patient has a history of heart disease, or there is an indication a heart problem is present. Unfortunately, the probability of a heart problem occurring where one did not exist before increases when a patient is over 50 years old. Physicians, therefore, will order a pre-operative EKG on patients over 50, even if no prior history or heart condition existed. This is a good medical practice and helps save patients and keep the physician out of a malpractice suit in case something does go wrong during surgery. However, Medicare will not pay for the EKG. The doctor and patient both want the EKG performed, as it can be a matter of life and death. So, if the patient cannot afford to pay for the EKG, the physician can usually find a diagnostic code that will allow the EKG to pass the Medicare medical necessity test. Certainly some procedures that fail the medical necessity rules will be canceled, saving some healthcare expenditures. It is wrong to believe that we can eliminate the practice of defensive medicine by creating more medical necessity rules as physicians and the patients will find a way around the rules when good medical practice and the defense against a malpractice suit require the procedure be performed. No amount of incentives to the contrary will stop this. Medicare has in place rules which lead to a reduced payment to hospitals for existence of preventable errors or the occurrence of never events, such as medication errors, hospital acquired infections, or surgery on the wrong limb. Hospitals, in the past, have taken these errors seriously and are continuing to monitor their systems for indications of these errors. Hospitals are continuing to monitor their controls to prevent these errors. Hospitals were doing this long before Medicare put in place the payment reductions where patients experienced these errors. Changing the payment incentives will likely not reduce the error rates or lead hospital management to suddenly decide that preventing these errors is important. Hospital management already knows preventing these errors is important and already has in place systems to identify and reduce the prevalence of these errors. Hospitals, nationally, are operating on thin margins and hospital management, in an effort to preserve a community’s access to healthcare, is acting to control costs. The alternative to not controlling costs is to have a community hospital become non-viable and the community to lose their access to healthcare. If we as a country decide preventing the types of errors that were listed in the Star Tribune article is essential, the solution would be for Medicare to fund additional staff positions at hospitals, increasing staff to patient ratios. This will give the hospitals the manpower needed to make further progress in the effort to reduce medical errors and never events.The article by Chen May Yee closes with this statement, “The promise of our healthcare system is to provide all Americans with access to healthcare that is safe, effective and affordable.” That is a wonderful goal, one nobody can disagree with. The laws of economics, those laws that the communist countries found could not be suspended, will continually frustrate our country’s efforts to attain this promise.
