Saturday, April 11, 2009

Big Brother Health Care Killing People

Another example of how big government means well and does harm:

Why 'Quality' Care Is Dangerous
The growing number of rigid protocols meant to guide doctors have perverse consequences.

By JEROME GROOPMAN and PAMELA HARTZBANDThe Obama administration is working with Congress to mandate that all Medicare payments be tied to "quality metrics." But an analysis of this drive for better health care reveals a fundamental flaw in how quality is defined and metrics applied. In too many cases, the quality measures have been hastily adopted, only to be proven wrong and even potentially dangerous to patients.

Health-policy planners define quality as clinical practice that conforms to consensus guidelines written by experts. The guidelines present specific metrics for physicians to meet, thus "quality metrics." Since 2003, the federal government has piloted Medicare projects at more than 260 hospitals to reward physicians and institutions that meet quality metrics. The program is called "pay-for-performance." Many private insurers are following suit with similar incentive programs.

In Massachusetts, there are not only carrots but also sticks; physicians who fail to comply with quality guidelines from certain state-based insurers are publicly discredited and their patients required to pay up to three times as much out of pocket to see them. Unfortunately, many states are considering the Massachusetts model for their local insurance.

How did we get here? Initially, the quality improvement initiatives focused on patient safety and public-health measures. The hospital was seen as a large factory where systems needed to be standardized to prevent avoidable errors. A shocking degree of sloppiness existed with respect to hand washing, for example, and this largely has been remedied with implementation of standardized protocols. Similarly, the risk of infection when inserting an intravenous catheter has fallen sharply since doctors and nurses now abide by guidelines. Buoyed by these successes, governmental and private insurance regulators now have overreached. They've turned clinical guidelines for complex diseases into iron-clad rules, to deleterious effect.

One key quality measure in the ICU became the level of blood sugar in critically ill patients. Expert panels reviewed data on whether ICU patients should have insulin therapy adjusted to tightly control their blood sugar, keeping it within the normal range, or whether a more flexible approach, allowing some elevation of sugar, was permissible. Expert consensus endorsed tight control, and this approach was embedded in guidelines from the American Diabetes Association. The Joint Commission on Accreditation of Healthcare Organizations, which generates report cards on hospitals, and governmental and private insurers that pay for care, adopted as a suggested quality metric this tight control of blood sugar.

A colleague who works in an ICU in a medical center in our state told us how his care of the critically ill is closely monitored. If his patients have blood sugars that rise above the metric, he must attend what he calls "re-education sessions" where he is pointedly lectured on the need to adhere to the rule. If he does not strictly comply, his hospital will be downgraded on its quality rating and risks financial loss. His status on the faculty is also at risk should he be seen as delivering low-quality care.

But this coercive approach was turned on its head last month when the New England Journal of Medicine published a randomized study, by the Australian and New Zealand Intensive Care Society Clinical Trials Group and the Canadian Critical Care Trials Group, of more than 6,000 critically ill patients in the ICU. Half of the patients received insulin to tightly maintain their sugar in the normal range, and the other half were on a more flexible protocol, allowing higher sugar levels. More patients died in the tightly regulated group than those cared for with the flexible protocol.

It gets worse. read the full article here:


  1. Excellent article. My husband practices medicine in MA and I actually know one of the authors of the study (Dr. Hartzband), and they are spot on. Obama's ram-through of socialized medicine in which care will be dictated by computer models and physicians will be relegated to simple conduits of providing care through these rigid guidelines will prove to be deadly medicine. Stop the madness!

  2. I hope you don't mind if I drop in again and invite people to view my post today. It has to do with basically the same thing...turning the USA into an OBAMA-Nation. My Saturdays have become my time to venture from being an author and posting writing tips and such, to having a voice as an American. I hope to make it louder so more people will get their heads out of the sand and pay attention.

    For the record, I'm not praying for Obama to fail, he's failing all on his own.

  3. Ginger Simpson said...
    "For the record, I'm not praying for Obama to fail, he's failing all on his own."

    For the record, prayer doesn't work, so pray away. Like many around here you probably want your president to fail, and thus your country to fail (how patriotic) but your claim is wrong anyway.


    "Americans More Optimistic; Still Hate GOP

    The latest New York Times poll is loaded with good news for the Obama administration and news that would be devastating for the GOP if it were ever able to penetrate the conservative-media echo chamber. While the public is still pretty pessimistic about the future, it's considerably less so than it was before Barack Obama took office. Thirty-nine percent of respondents in the Times poll think the country is going in the right direction and 53 percent say the wrong direction, a substantial improvement from January, when the numbers were 15 and 79, respectively. Similarly, 20 percent of those polled think the economy is getting better and 34 percent worse, versus 7 and 54 in January.

    But it's the political numbers that are truly striking. Obama has a 66 percent approval rating, which is the highest this poll has recorded, while the GOP's favorability is at 31 percent, the lowest the poll has recorded in 25 years of asking the question. Arguably more remarkable still is that, asked whether Obama or the GOP Congress would be more likely to make "the right decisions about the nation's economy," respondents broke for Obama 63 percent to 20 percent. That means that even within the 31 percent rump that holds a positive view of the GOP, at least a third trust Obama's instincts on the economy equally or more. And why shouldn't they? Despite Rush Limbaugh's best efforts just 2 percent of respondents blame Obama for the state of the economy, compared to 33 percent who blame George W. Bush."
    --New Republic, April 7, 2009


    I bet FOX News forgot to tell you about this. I'm so surprised!