(Re)Admitting Mistakes

  • by: |
  • 10/11/2012
In a WSJ op-ed a while back,  Donald Berwick, Ezekiel Emanual and someone else I don't remember claimed that Obamacare and Medicare reform was really all about using market forces.  I've discussed the absurdity of this claim in previous posts but then again it I fully expect anyone who flacks for the Obama administration on almost anything to say the exact opposite of the facts.   Three million young adults have health insurance thanks to Obamacare?  Who cares if the real number is under 250,000.    Millions of seniors got rebates and free drugs?   Let's ignore the fact that the administration is shoving more new drugs under Part D so they don't have to pay a larger share under part B.

Ditto this claim that market forces and pay for performance will save Medicare tons.   

Here's the lede about the results of yet another Medicare demonstration project that saved no money...

Medicare penalty fails to curb hospital-acquired infections
By Karen Cheung-Larivee

Four years after the Centers for Medicare & Medicaid Services discontinued payments for preventable hospital-acquired conditions (HACs), new research finds that the policy had no effect on curbing infections, published today in The New England Journal of Medicine.

In October 2008, CMS discontinued additional payments for preventable HACs, according to the American Society for Healthcare Risk Management:

Vascular-catheter-associated infection
Catheter-associated urinary tract infection
Pressure ulcers (stage III and IV)
Falls and trauma
Surgical site infection after bariatric surgery for obesity
Certain orthopedic procedures
Bypass surgery (mediastinitis)
Administration of incompatible blood
Air embolism
Foreign object unintentionally retained after surgery
Although the policy only cut back an average of six-tenths of a percent of Medicare revenue, according to The Boston Globe, it was a high-profile policy change toward a pay-for-performance approach to reimbursement.

Researchers looked specifically at data from 2006 through 2011 on central catheter-associated bloodstream infections and catheter-associated urinary tract infections and compared infection data against rates of ventilator-associated pneumonia, which is not under the nonpayment policy.

The result: Researchers found "no evidence that the 2008 CMS policy to reduce payments for central catheter-associated bloodstream infections and catheter-associated urinary tract infections had any measurable effect on infection rates," study authors wrote.

Still, researchers acknowledged that hospital infection rates are falling overall.

Although infections rates have generally dropped since 2006, it wasn't because of the Medicare penalties, U.S. News and World Report's HealthDay reported.

"It had really nothing to do with the CMS policy," Grace Lee, associate professor at Harvard Pilgrim Health Care Institute and Harvard Medical School, told The Boston Globe.

The downward trend was happening well before policy implementation, due to hospitals taking charge of infections. Hospitals may already haven taken big steps to control infections in the years prior, Lee said.

The overall improved infection rates also may have more to do with rigorous coding procedures, in which case, the improved rates demonstrate better administrative skills rather than better quality, HealthDay noted.

The research strengthens some providers' discontent with the federal agency's "stick" approach, in which CMS halts reimbursement for what it deems preventable or avoidable events.

American Hospital Association Vice President Nancy Foster told The Wall Street Journal the study should make policy makers "take a step back and say, 'Are payment penalties the right way to go; do they actually add to the efforts?' on reducing infections and other hospital-acquired conditions?"

Post-election,  the $10 billion or so in new money for all these demonstration projects should be ripe for elimination.   

The best way to stop an infection from spreading is to get at the underlying cause....

Center for Medicine in the Public Interest is a nonprofit, non-partisan organization promoting innovative solutions that advance medical progress, reduce health disparities, extend life and make health care more affordable, preventive and patient-centered. CMPI also provides the public, policymakers and the media a reliable source of independent scientific analysis on issues ranging from personalized medicine, food and drug safety, health care reform and comparative effectiveness.

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