Comments on: Medicare ceases to pay for medical errors http://www.kevinmd.com/blog/2007/08/medicare-ceases-to-pay-for-medical.html medical blog Sun, 22 Nov 2009 19:59:44 -0500 http://wordpress.org/?v=2.8.4 hourly 1 By: Anonymous http://www.kevinmd.com/blog/2007/08/medicare-ceases-to-pay-for-medical.html/comment-page-1#comment-79299 Anonymous Tue, 21 Aug 2007 00:51:00 +0000 http://clients.emmense.com/kevinmd/2007/08/medicare-ceases-to-pay-for-medical-errors.html#comment-79299 In a fixed price system like medicare, where the only way to increase revenue is to increase the volume of services, bad care is more profitable than good. You not only spend less time providing it (for the same fixed reimbursement) but you also get to treat (or pretend to treat) the complications. The only payment system that rewards good care more than bad is one in which those who can plausibly claim superior care can demand higher fees for their services.<br/><br/>For the lack of this, the quality of American medicine is being progressively eroded to the extent that fixed-price systems (Medicare, medicaid, monopsony private insurance) take more and more of the market. In a fixed price system like medicare, where the only way to increase revenue is to increase the volume of services, bad care is more profitable than good. You not only spend less time providing it (for the same fixed reimbursement) but you also get to treat (or pretend to treat) the complications. The only payment system that rewards good care more than bad is one in which those who can plausibly claim superior care can demand higher fees for their services.

For the lack of this, the quality of American medicine is being progressively eroded to the extent that fixed-price systems (Medicare, medicaid, monopsony private insurance) take more and more of the market.

]]> By: Anonymous http://www.kevinmd.com/blog/2007/08/medicare-ceases-to-pay-for-medical.html/comment-page-1#comment-79297 Anonymous Tue, 21 Aug 2007 00:46:00 +0000 http://clients.emmense.com/kevinmd/2007/08/medicare-ceases-to-pay-for-medical-errors.html#comment-79297 Perfectly logical, but like every other effort to regulate an art through a centralized beaurocracy, the law of unintended consequences will not be violated. Perfectly logical, but like every other effort to regulate an art through a centralized beaurocracy, the law of unintended consequences will not be violated.

]]> By: Anonymous http://www.kevinmd.com/blog/2007/08/medicare-ceases-to-pay-for-medical.html/comment-page-1#comment-79274 Anonymous Mon, 20 Aug 2007 17:06:00 +0000 http://clients.emmense.com/kevinmd/2007/08/medicare-ceases-to-pay-for-medical-errors.html#comment-79274 Anyone with a hint of medical knowledge knows that UTIs in cath patients are fact of life - especially in the elderly and diabetics. Perhaps it would be better to not put a cath in and let them get hydronephrosis and overflow incontinence. The ensuing renal failure and dialysis will presumptively be paid for, I guess.<br/><br/>Unfortuntely, the hospitals taking care of the oldest, sickest patients will be penalized while the those that dump their problems on others will be rewarded. <br/><br/>This is a another extension of the victim philosophy which is driving patients to the courts. No one wants to understand that some complications are not due to negligence, but due to many other factors outside of the provider's or hospital's control.<br/><br/>I am afraid we are just seeing the first step in this process...it won't be long before Medicare refuses to pay physicicans (as opposed to just hospitals) for care it deems to be due to a "complication." This will only serve to drive a bigger wedge between providers and the sickest and riskiest patients. Anyone with a hint of medical knowledge knows that UTIs in cath patients are fact of life – especially in the elderly and diabetics. Perhaps it would be better to not put a cath in and let them get hydronephrosis and overflow incontinence. The ensuing renal failure and dialysis will presumptively be paid for, I guess.

Unfortuntely, the hospitals taking care of the oldest, sickest patients will be penalized while the those that dump their problems on others will be rewarded.

This is a another extension of the victim philosophy which is driving patients to the courts. No one wants to understand that some complications are not due to negligence, but due to many other factors outside of the provider’s or hospital’s control.

I am afraid we are just seeing the first step in this process…it won’t be long before Medicare refuses to pay physicicans (as opposed to just hospitals) for care it deems to be due to a “complication.” This will only serve to drive a bigger wedge between providers and the sickest and riskiest patients.

]]> By: Dr. A http://www.kevinmd.com/blog/2007/08/medicare-ceases-to-pay-for-medical.html/comment-page-1#comment-79269 Dr. A Mon, 20 Aug 2007 14:48:00 +0000 http://clients.emmense.com/kevinmd/2007/08/medicare-ceases-to-pay-for-medical-errors.html#comment-79269 Thanks for the link! Thanks for the link!

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