Dollars = quality (sort of)

John Taylor: January 29, 20070 Comments

They tried to stitch up a gash in my daughter's chin without anesthetic or cleaning the wound ... Nobody on the medical staff washed their hands as they went from patient to patient ... A used syringe was discarded into a paper bag where the patient put her discarded tissues  ... The same smock worn while eating pizza -- extra tomatoes please -- was still on while wheeling a patient to radiology.


Everyone has complaints about the quality of medical care, and how poorly those complaints are often received by the presiding authorities. The ones I've mentioned are just of few I've experienced at various Fresno health facilities over the last 25 years.  If you need more proof, snare a copy of the January 2007 AARP bulletin, which has a compelling front-page feature on the deadly consequences of inattention to quality -- as well providing preventive/defensive measures and helpful Web sites.


Private insurers and the federal government are mounting a nationwide push that provides bonus payments to hospitals that implement various quality measures, like giving antibiotics to pneumonia patients and aspirins to those suffering heart attacks. Inevitably, that means hospitals delivering substandard care will be paid less and, presumably, measure up or disappear.


A recent study casts doubt on the effectiveness of that pay-for-performance strategy. A New England Journal of Medicine study cited by the Wall Street Journal reported that hospitals taking part in a pay-for-performance trial project showed only modest improvements over other hospitals when their results were adjusted for variables like hospital size and patient volume.


The good news is that the quality push is on and won't be going away.  There are plenty of unfunded government mandates -- somehow, the concept of government paying extra for quality sounds oddball, like quality somehow is discretionary.  We don't cover our sneezes, and some of us still spit in the streets.  Still, being paid more for providing appropriate care, which the public has a right to expect, shows how far we've slipped  -- and the urgency to get cracking.