consultants are sandburs

Thursday, April 18, 2013

Surprising news? An epiphany on the road to Damascus, Toledo, Detroit, wherever? Hardly. If it is plain a system is broke, fix it. If bleeding cash away from productive activity, staunch the cash hemorrhaging. Do not let special interests intervene. YOU DECIDE: Is it "Best" healthcare in the world? Or simply, "Most Expensive" with cost/benefit out-of-whack and needing more than a bandaid, more than Congress as presently made up, may care to give us?

Malpractice is its own reward? Not even on "House," you say?

But, in America, our US of A, what's the story?

NPR, here. Catch 22 alive and prospering. This extended quote:

Hospitals can make much more money when surgery goes wrong than in cases that go without a hitch.

And that presents a problem for patients. The financial incentives don't favor better care.

"The magnitude of the numbers was eye-popping," says Atul Gawande, a professor of surgery at Harvard Medical School, and an author of the study, which was just published in JAMA, the Journal of the American Medical Association. "It was much larger than we expected."

If a patient with private insurance had complications after surgery, hospitals made $39,017 more profit than if all had gone well. That's compared to an additional profit of $1,749 for a Medicare patient with complications after surgery.

"That's an indication of the level of perversity here," Gawande says. "Having a complication was profitable, and fighting complications was highly unprofitable."

It's not surprising that health care costs are higher when there are complications, since patients need more care to get better. And it's not surprising that hospitals bill private insurers at a much higher rate than Medicare.

There was no profit with Medicare patients. The paper used "contribution margin," which is revenues minus variable costs. In other words, the expense of items used directly for a patient's care, not overhead or other fixed costs.

The much higher margin on cases involving mistakes is enough to make a patient think that hospitals aren't highly motivated to reduce medical errors. In fact, one reason that Gawande and his colleagues embarked on the study is that many hospitals have been slow to adopt practices proven to improve the quality of care and save money.

"We have never seen hospitals that are actively trying to cause complications to make a profit," Gawande told Shots [i.e., this NPR "Shots" site]. "But we've seen a lot of hospitals where you say, "Why aren't you investing in reducing risk, the way other industries do?' "

The researchers looked at 34,000 surgeries at 12 hospitals in the Texas Health Resources system in 2010. About 5 percent of people experienced complications. That included surgical site infection, sepsis, pulmonary embolism, stroke, heart attack, pneumonia and other infections.

The study was part of a larger effort to improve quality in the system.

"It's just more evidence that payment reform is key to health care reform," says Mark Lester. He's executive vice president of Texas Health Resources, and a co-author of the paper. "We've unmasked some hidden perverse incentives that are just part of our system."

But, that's Texas, and we, the rest of us are a civilized nation, right? Go figure. Same pool of doctors, same pool of private insurers, same broke and needing fixing system, nationwide. And the mess Congress/Obama/Baucus/Big Pharma/Big Insurance and the entirety of healthcare industrial complex and its many well funded lobbying and propaganda arms created and handed to us, it's a nationwide morass as well, vs successful single payer such as veterans get through "socialized medicine" aka, the VA.

By the way, photo credit, here, i.e., from: honestcooking.com

It is good to see something honest, these days.

Texas Health Resources' online blurb, here. Kaiser gives more links. This google. JAMA's abstract, here (the full item is behind a paywall).

And it is not a tale without its own surprise. Mainstream media is reporting it. That is a surprise.

But allowing HMO and hospital bean counters the driver's seat within our hospitals and clinics, with dedicated (vs rapacious) medical staff semi-marginalized to the dollar counters, is a formula for what we've got vs. what we expect, which after all, is what we deserve. Indeed, what we should DEMAND.

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