The heat is on.
Just as the television networks are rolling out their latest cop programs, the quality police are staging some shows of their own. The difference is that the latter are reality-based, with the dramas featuring serious misdeeds and potentially serious punishment. Consider these new offerings:
* An audit finds troubling lapses in oversight of New York state's tracking system for deaths, injuries and medical mishaps (Oct. 4, p. 6).
The report, released by the state comptroller and the health commissioner, showed that regulators were lax in holding hospitals to prescribed timelines for reporting adverse events, and that officials had meted out penalties to only a handful of noncomplying facilities. They also rarely insisted that the offending hospitals write a corrective action plan.
Investigators also found that medical facilities did a fairly good job of reporting not-so-serious events and a bad job of reporting the really big boo-boos.
The audit, not surprisingly, stirred a firestorm of criticism. New York providers should brace themselves for the enforcement sweep that's likely to follow.
* The Minneapolis Star Tribune reports that HealthPartners, one of Minnesota's biggest health plans, won't pay for botched medical procedures. Starting Jan. 1, 2005, the insurer will stop subsidizing debacles such as operating on the wrong body part or leaving surgical instruments inside a patient.
The only surprising thing about this development is that the cops took so long to discover a crime and enforce the law. Other insurers, no doubt, will be watching this show closely.
* The big fall blockbuster can be seen in the Web edition of Health Affairs. Studies and articles featured in the edition spotlight the enormous medical practice differences between providers in different facilities. The highlight of the issue is something that might be called "CSI: Medical Care." The research emanates from Dartmouth Medical School and was led by physician John Wennberg, who has spent decades documenting how a cold sufferer can go to the doctor in Missouri and be given an aspirin and go to Florida and get sinus surgery. In this episode, Wennberg and his fellow sleuths discover that they can use Medicare claims to analyze care at specific hospitals.
And in a nice twist, they do a number on the much-publicized U.S. News and World Report annual list of "best" hospitals. They illustrate that utilization is all over the map for these facilities. For example, a geriatric patient can expect to spend almost twice as many days in New York's Mount Sinai Medical Center as in the Mayo Clinic's hospital in Rochester, Minn. Intensive-care unit days for geriatric patients at the University of California, Los Angeles Medical Center were three times greater than those of seniors at Massachusetts General Hospital in Boston.
Another study examining three classes of patients in nearly 300 teaching hospitals concluded that patients in the highest-intensity facilities spend more time in the hospital and the ICU. They also have more frequent physician visits in the hospital, have more specialists involved in their care and receive more diagnostic tests and minor procedures. And for all of this, they are no better off when it comes to survival. In fact, for two of the illness categories (heart attack and colorectal cancer), higher intensity services were associated with a small but significant increase in the risk of death.
What will happen as a result of these findings is uncertain. Wennberg notes that medical practice variation is "remarkably resistant to change." But private and government insurers are getting tired of picking up inflated bills. After these studies, you can expect at least an attempt at a crackdown on unjustified utilization. Hospitals and physicians should grab a cold drink while they can-they may be spending a lot of time under the hot interrogation lights. This case is not closed.