[HSF] Why should Health Purchasers pay for the cost of our complications?

[Ani Anyanwu]

I think this issue of Medicare not 'paying' for mediastinitis is being looked at the wrong way. 
 
Medicare is not refusing to pay for a complication per se - what is happening is that they are penalizing (fining) hospitals for complications that occur. This then provides an incentive for hospitals to reduce their complication rates. Similar approaches have been used in the British National Health Service with hospitals fined, or subsidies deducted, if they did not meet specific Department of Health quality targets. 
 
Hospitals will still get paid for doing the procedure but what it means is hospitals with high complication rates will have higher unreimbursed costs. There is nothing wrong with this situation per se as it exists in most walks of life - people who provide less quality service or inferior goods get penalized financially and people or products which deliver higher quality service cost more to purchase. Health economists will have no problem at all with this. Indeed they would wonder why, for example, a hospital with a 5% mortality rate, one with a 10% infection rate, one that transfuses 70% of patients should all be paid the same for a CABG as one with a 1% mortality, 0.5% infection and 10% transfusion rate. The present state of affair where there is uniform reimbursement for all manners of delivery of health care is scandalous.  If you went to buy any other commodity you would not expect to pay the same for products of such diverse quality. A car manufacturer could not charge 20,000 USD for a car whose brakes failed every other day and expect to stay in business, yet we would keep getting paid same for a pneumonectomy, and feel we are entitled to be paid the same, even if all our patients died or developed bronchopleural fistula.
 
Of course I know I am in the minority but changes like this are inevitable because the present system of US healthcare funding and payment, and that of even welfarist systems like the United Kingdom, and self-pay systems as in many less developed countries, is not sustainable.
 
Ani



> From: msfirst at gmail.com> Subject: Re: [HSF] post op mediastinitis discussion> Date: Wed, 3 Oct 2007 00:18:27 -0400> To: OpenHeart-L at lists.hsforum.com> CC: > > This is going to be a disaster. By not willing to pay for a problem, > CMS thinks that the problem will go away. We think that these (and > other major non-cardiac wound problems) will all end up at major > medical centers because the primary surgeons will not take them back > (in part since they and their systems will not get paid - and who can > blame them since we do enough free work). Although, from what I > heard, you can still get paid for someone else's problems - which > means all of the major medical centers will get all of these patients > - gee, that sounds like a money saving plan. Who is going to win > out? Of course the MedMal lawyers - that is a no brainer.> On Oct 2, 2007, at 11:47 PM, Douville, Chuck wrote:> > > This discussion is relevant to our cardiac surgery colleagues > > around the world, although it is a financial issue only in the USA. > > CMS (center for medicare services), the agency responsible for > > medicare healthcare funding in the US recently announced it would > > no longer pay hospitals for costs due to postoperative > > mediastinitis in cardiac surgery patients effective within the next > > year. Despite perfect glucose control, antibiotic timing etc, my > > own recent morbidly obese re-do AVR pt had his chest open 7 hours > > due to difficult adhesions. S. epi wound infection on day 6 > > required opening his sternum, VAC therapy and IV antibiotics and an > > extra week in the hospital. The only way to avoid the infection in > > this pt that I can think of is to deny the operation to a 60 yr old > > man with critical AS after previous CABG 6 years earlier. I do not > > believe the incidence of this problem can ever be zero. Thoughts?> > _______________________________________________> > OpenHeart-L mailing list> >> > Send postings to:> > OpenHeart-L at lists.hsforum.com> >> > To UNSUBSCRIBE, to CHANGE email address, or to view archives:> > http://mmp.cjp.com/mailman/listinfo/openheart-l> >> > All messages transmitted by the OpenHeart-L are subject to the > > policies and> > disclaimers posted at:> > http://www.hsforum.com/listdisclaim> > -----------------------------------------> > _______________________________________________> OpenHeart-L mailing list> > Send postings to:> OpenHeart-L at lists.hsforum.com> > To UNSUBSCRIBE, to CHANGE email address, or to view archives:> http://mmp.cjp.com/mailman/listinfo/openheart-l> > All messages transmitted by the OpenHeart-L are subject to the policies and > disclaimers posted at:> http://www.hsforum.com/listdisclaim> -----------------------------------------
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