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

Thu Oct 4 12:06:28 EDT 2007

But that part of the point that I mentioned previously.  As Hal recently
brought up, if he sees a patients who has a 5-10% risk for a deep wound
infection (in his hands.... meaning 20% in mine) then he may not offer that
patient surgery.  this then becomes a way of rationing - if Hal wants to do
the surgery and take the risk for a wound infections - and all of the
headaches that come with it - fine but the end result is denial of service
to patients because of financially based risk factors.  I know of several
surgeons who believe the 5% DSWI risk for BIMA in DM is offset in the long
run by performing total arterial revasc. - will that change will these new
rules?

-michael

On 10/4/07, Douville, Chuck <ecdouville at orclinic.com> wrote:
>
> Ani, I respectfully disagree. It is one thing to insist on excellent
> mortality statistics; there was the long standing worry about denial of care
> to high risk patients. The shifting of risk to out of state hospitals was
> one documented side effect of this. Once you get in to $100,000 of free care
> for an unavoidable, albeit rare, complication, I believe you then force a
> dialogue between hospital leaders (business folks) and physicians, which
> will unavoidably lead to denial of care to higher risk patients, not as much
> for death, as for complications.
> Maybe it is ok, as long as it is someone else?
>
> ________________________________
>
> From: openheart-l-bounces at lists.hsforum.com on behalf of Ani Anyanwu
> Sent: Wed 10/3/2007 5:34 PM
> To: openheart-l at lists.hsforum.com
> Subject: RE: [HSF] Why should Health Purchasers pay for the cost of
> ourcomplications?
>
>
>
> 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?> >
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