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

Fri Oct 5 08:26:45 EDT 2007

Oh please - of course they are all concerned about limiting health care to their constituants.  Free health care is like mom and apple pie... They are politicians arnt they someone had to vote to approve this.  Then again maybe Bush vetoed the wrong health care bill.

Michael Firstenberg <msfirst at gmail.com>

-----Original Message-----
From: "Wertheimer MD, Mark" <mwertheimer at mahealthcare.com>
To: OpenHeart-L at lists.hsforum.com; OpenHeart-L at lists.hsforum.com
Sent: 10/4/2007 6:36 PM
Subject: RE: [HSF] Why should Health Purchasers pay for the cost	ofourcomplications?

These kinds of discussions are like preacing to the choir. We all agree on this issue. What we all need to do is bring this issue to our congressional representatives because the net effect of this legislation will be to deny health care to their constituants (VOTERS). I have just returned from the "Hill" participating  in the STS Legislative Advocacy Workshop and I found that all the legislators I met were uniformly concerned about anything that would result in loss of health coverage for their constituants. If you don't know how to contact your Senators or Representatives, call the STS Wasington DC office @ 202 481-1028 and they will help you make that contact.

________________________________

From: openheart-l-bounces at lists.hsforum.com on behalf of Michael Firstenberg
Sent: Thu 10/4/2007 10:06 AM
To: OpenHeart-L at lists.hsforum.com
Subject: Re: [HSF] Why should Health Purchasers pay for the cost ofourcomplications?

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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