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Hospital report cards don't deliver better care

Newspapers are publishing hospital Medicare report cards, implementing one of the most dangerous health system reforms of the president — President George W. Bush. Sadly, President Barack Obama is continuing the plan to issue hospital "report cards" to grade their adherence to "best practices" created by committees.

The insurance companies are leading the way by grading doctors on how well they cut costs for the companies. Patients know that no committee could ever decide how to practice medicine best. They expect and deserve to get the best advice on medical care from their independent doctor.

Hospitals, rightfully concerned that they will be rated poorly in local papers, work hard to ensure their scores meet government standards. Unfortunately, meeting a government standard is not the same as providing good health care, decreasing suffering or increasing life expectancy.

But that is not the real goal of these report cards. Report cards are a key step in pay-for-performance programs designed to do one thing: cut spending on medical care by controlling how doctors make medical decisions. In fact, hospitals and doctors are punished financially if they don't report the data or meet arbitrary standards set by the government and insurance companies.

Doctors and hospitals end up more worried about whether they gain a bureaucratic seal of approval than meeting the patient's most important needs.

Dozens of scientific studies have shown that report cards and incentive payments for performance do not improve quality of health care. The report cards also cause doctors and hospitals to avoid sicker patients or game the system to get a better score. There has actually been direct harm to patients from complying with practices the government deems as "best."

For example, the government had to "retire" a measure on giving beta blockers within 24 hours of a heart attack when it was shown to cause shock and death in patients with heart failure. The measure started in 2005 and stayed in effect until 2009 even though the study used to end it was published in 2005.

In referring to this measure, the government said "reporting initiatives may adversely affect the way physicians practice medicine and ultimately harm patients." In another case, Medicare had to ultimately allow certain heart medications for heart failure it first denied. The Society of Thoracic Surgeons had to fight to allow antibiotics after open-heart surgery to be given for 48 hours instead of 24 — after a year of bad policy. Hospitals were pushed to give antibiotics to pneumonia patients within four hours of presentation — even though this encouraged them to accidentally give them to heart-failure patients that mimicked pneumonia.

Elderly patients are receiving repeat doses of pneumonia vaccine since the hospital is measured on vaccination too. The hospital inadvertently treats the wrong patient to get a good report card on "compliance."

The reason for bad hospital practice is the regulators' financial "incentive," or penalty. In Medicare, hospitals' payments are cut 2 percent if they don't report data. Bush encouraged punishing doctors and hospitals in this way in 2004, and it is a centerpiece of Obama's proposals. Many Republicans like this centrally planned cost-control measure because it gives insurance companies more power to cut health care spending — also known as rationing.

Bill Clinton received great medical care and was home with two coronary artery stents within 18 hours of seeing his doctor. This relieved his chest pain and allowed him to return to work.

Unfortunately, that choice is about to be denied to patients of Blue Cross of New York. It will require patients to endure 12 weeks of chest pain to see if they are in the group of patients who can relieve it with medication alone. This is a prime candidate for an "incentive program" but will force patients to suffer longer and be less active.

Such a program would pay hospitals and doctors less if they dared spend money on their patients to relieve their pain. To ensure your doctor works for you, pay-for-performance and report cards must be rejected by the American people. There are better ways to control cost than by empowering bureaucrats.

Dr. David McKalip is the immediate past president of the Florida Neurosurgical Society and founder of Doctors for Patient Freedom, whose Web site,, details the many risks, in his view, of pay-for-performance.

Hospital report cards don't deliver better care 02/26/10 [Last modified: Friday, February 26, 2010 6:01pm]
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