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December 26, 2004
New York Times Almost Gets It!
This article praises the Medicare and Veterans Administration for instituting reforms that are saving lives across the country. Some exerpts.
The Problem:
- Lifesaving treatments often are forgotten while doctors and hospitals lavish patients with an abundance of care, which can involve expensive procedures of questionable value. The results are high costs, unnecessary medicine and wasted opportunities to save lives and improve health.
- ...Medicare administrators decided to focus on just a few treatments at first, for a few common diseases - pneumonia, heart attacks and heart failure - where there was little controversy about whether those treatments worked and an abundance of data showing that doctors and hospitals often did not provide them.
- But not long ago, only 30 percent of V.A. patients who should get the vaccine received it (the national average is 50 percent). The rude awakening came when the department showed individual teams of doctors and individual clinics and hospitals how often they were vaccinating and how their rates compared with those of other medical teams. "It's pretty revealing to have the data," Dr. Perlin said. "Absent the data, you think you are doing a pretty good job."
Now 90 percent of V.A. patients who should get the vaccine do.
"By increasing the rate of pneumonia vaccination just for patients with emphysema, the V.A. saved 6,000 lives," Dr. Perlin said.
- So the agency asked the nation's hospitals to report how well they did in providing these treatments if they wanted this year's cost-of-living increase in Medicare payments. Ninety-eight percent complied.
Medicare expects that now that the hospitals' performances are public, many will try to improve. "People will begin to feel a little awkward if everyone else is doing better and they're not," Dr. Jencks said.
The next step, Dr. Jencks said, is "aligning payment with what you want people to do."
To that end, Medicare has a pilot program to pay hospitals for improving on a number of quality measures, including mortality rates and readmission rates for hip or knee surgery. Hospitals in the top 10 percent for a given condition, for example, will be paid an extra 2 percent. The agency will pay less if performance deteriorates. The project involves 278 hospitals affiliated with Premier, a nationwide organization of nonprofit hospitals.
Dr. Jencks said he expected that in the future hospitals and doctors would be paid according to whether they gave patients treatments that worked. "It is very clear that we are moving toward pay-for-performance," he said.
So what word or phrase was conspicously absent from the article?
How about "Bush Administration"?
Posted by crandal at December 26, 2004 10:34 PM