Friday, August 31, 2007

Consequences of Medicare's new don't pay for certain problems policy

Dr. RW discusses some of the problems associated with Medicare's latest ploy to decrease costs. You can bet there will be predictable consequences and some others we might not be smart enough to predict.

In my consultative foray into certain limited aspects of occupational medicine, I had the opportunity to see some consequences of a OSHA program which on the face on it was designed to improve workplace safety. Employer are supposed to record on a form (at the time the OSHA 200 form) certain injuries at work. Plant managers looked at the statistics and the safety officers were either given high marks or trouble depending on the numbers. If the safety officer were imaginative enough he could turn a real injury into one that did not require recording but the event still occurred. If an employee twisted his ankle on a slick walkway it would not be recorded if he could accompany the employee to the ER and convince, cajole the ER doc to treat the worker without using a prescription medication as that would trigger a recording. Basically the record was treated and more time was spent playing the game than working to improve workplace safety ( at least in some instances).

You can be certain that hospitals will be as least as devious and clever as some workplace safety officers and will devise ways to treat the record or spin the facts or something to minimize the "occurrence" of those complications the treatment of which will be no longer paid for by CMS. Hospitals will find ways to cheat and it is very unlikely that those ways will improve patient care.

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