I’m all for things that make the environments safer by all means and the program for controlling items like MRSA and other items as such are good but I’m looking at this model overall and I think it needs a bit of a fix.  We have hospitals that are barely making it, rural hospitals closing right and left and then we have the quality metrics.  Those with the worst rates automatically lose 1 percent of their Medicare payment, so 25% of the hospitals are in the barrel every month as this begins in October.  It can make budgets hard to project and meet as well for those on the line. 

Public hospitals and some non profits will get hit hard as well as some teaching hospitals, soimage73 what are they going to do if the penalties rank up there due to “teaching” errors, get rid of residents.  I hate to say it but we could be headed right down the same path as what we have been seeing at the VA as we are a nation of “Stat Rats”.  People will hide stuff and cheat if it means the continued operation of the hospital and jobs. 

With the numbers cited here one out of eight have experienced a potentially avoidable complication, but let’s take into effect the disruptions that also add to all of this.   People forget that hospitals have things flying at them from all directions, new procedure changes occur frequently so that adds to it.   The article says that government targets are not being met. Well where did the government get those targets?  A little bird that used to work for CMS kind of told me that when CMS got stuck they could always depend on United Healthcare/Optum to crank out some numbers for them to bail them out, so maybe if that’s true, maybe that’s the reason the attainment is set too high as we see it a lot with doctors and their quality measurements that United sets.  That company lives off of analytics without enough human balance in their business plans for the most part anyway.   Here’s a post from a couple years ago on how they lay off people, instant message, report to the lobby, bus take them to a hotel and they are given walking papers, nice huh? 

UnitedHealthcare Lays Off 180 Employees In Orange County-Initial Notification Sent By Instant Message to Those Affected

In reading the article it states even infection rates are not decreasing fast enough so it is humanly possible to meet these goals.  I write about this too with models that don’t work in the real world and it sounds like we have a bit of that here as people are going to work hard and diligently as people like to help people and do the right thing but again think about this and are we headed down the same path as the VA?

When we have the mis-distribution of money that we have today, do penalties work?  In better  time maybe.  So let’s take a listen here to a Quant that develops financial models and he’ll tell you straight up that things change all the time and there are variations so “it’s never going to be 100 bottles of beer”…the patients and illnesses are going vary.  You don’t just multiply one by a hundred and as Paul Wilmott says “that’s not the real world”.

This somewhat unwelcomed phenomena that exists today…”The Grays”….
Virtual Worlds, Real World We Have A Problem And It’s A Big One With A Lot of Gray Areas Finding Where The Defining Lines Exist, Confusing Many With A Lot of Weird Values And Strange Perceptions…

So again CMS might want to reconsider this model and think about it.  Reducing infections is pretty straight up and I think all can live and understand those metrics we know what they are.  It’s going to get pretty gray out there though when you start awarding bonuses for quality metrics and again look what the VA did.  If the patient’s condition doesn’t meet the coding and needs another night, they work around it to help the patient and it just adds more disruption with meeting provisions rather than taking care of the patient. 

We just had the latest hospital ratings out today, and nobody cares except the CEOs that run the hospitals.  I saw the report and then almost every CEO or PR Department had to go run to Twitter to brag…who cares.  We saw the report already.  Enough is enough.  We have this stupid 5 Star Quality program at CMS too, again nobody cares as we want to know what facilities are left and in network where we can go when you look at the consumer side of it.  Everyone has a #1 award for something today and frankly we don’t care anymore as consumers, we have too much else going on in our lives. 

I want good care when I go to a hospital but what I don’t want to see is doctors and nurses so frazzled that they get distracted with all their quality measures to give me the care that went there for in the first place and we are seeing some tell tale hints of this already.

How unbearable are going to make getting healthcare to meet metrics?  It should be a people friendly effort and not numbers first.  I have friends and some of them seniors asking me of late “what’ wrong with doctors anymore” and of course they know little or nothing of this side of the scenario. 

VA Crisis Just The Tip of the Iceberg As US Needs a Full On Healthcare Culture Change Everywhere To Get Back In Touch With the Real World of Patients…

As we are finding out in other areas of life “people don’t’ work that way”.   Goals have to be attainable and not just what one “thinks” it should be and it’s driving everyone crazy to be over nit picked and be able to perform their jobs. 

People Don’t Work That Way” A World of Broken Software Models That Don’t Align To the Human Side,Too Much Push At Times With Only A Proof of Concept That Fails in the Real World..

CMS has been sucking down somebody’s Kool Aid of late as I mentioned above and they should take a look at their model here as some is fine but some really needs a human touch and and a little escape from the “Stat Rat” routine if you ask me.  We are not going to save all the money that Lewin, United, McKinsey and others touted for the last 10 years on the internet.  All you have to do is look back and see how erroneous their predictions were, not even close and were more fiction than fact, usually created to market something anyway.  BD   

By the time they operated on her again, she was so weakened that she was placed in a medically induced coma at Vidant Medical Center in Greenville, N.C. On a respirator for six weeks, she contracted pneumonia.

"When they stopped the sedation and I woke up, I had no idea what had happened to me," said Handron, 60. "I kind of felt like Rip Van Winkle."

Because of complications like Handron's, Vidant, an academic medical center in eastern North Carolina, is likely to have its Medicare payments docked this fall through the federal government's toughest effort yet to crack down on infections and other patient injuries, federal records show.

A quarter of the nation's hospitals -- those with the worst rates -- will lose 1 percent of every Medicare payment for a year starting in October. In April, federal officials released a preliminary analysis of which hospitals would be assessed, identifying 761.

When Medicare sets final penalties later this year, that list may change because the government will be looking at performance over a longer period than it used to calculate the draft penalties. Vidant, for instance, says it lowered patient injury rates over the course of 2013, and Handron praises its efforts.

Medicare's penalties are going to hit some types of hospitals harder than others, according to an analysis of the preliminary penalties conducted for Kaiser Health News by Dr. Ashish Jha, a professor at the Harvard School of Public Health. Publicly owned hospitals and those that treat large portions of low-income patients are more likely to be assessed penalties. Preliminary penalties were assigned to more than a third of hospitals in Alaska, Colorado, Connecticut, the District of Columbia, Nevada, Oregon, Utah, Wisconsin and Wyoming, Medicare records show.

The biggest impact may be on the nation's major teaching hospitals: 54% were marked for preliminary penalties, Jha found. The reasons for such high rates of complications in these elite hospitals are being intensely debated.



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