Washington Post Publishes Three-Part Series on Quality of Care in Medicare
The Washington Post this week is publishing a three-part series on quality of care in Medicare.
On Sunday, the Post looked at the relationship between Medicare spending and quality of care. The Post on Monday examined Medicare oversight and the program's relationship with the Joint Commission on the Accreditation of Healthcare Organizations. On Tuesday, the final part in the series will examine Medicare's Quality Improvement Organizations, a network of private groups on which Medicare spends nearly $300 million annually.
Summaries of the first two parts of the series appear below.
- "Bad Practices Net Hospitals More Money": According to the Post, under Medicare's "upside-down" reimbursement system, "hospitals and doctors who order unnecessary tests, provide poor care or even injure patients often receive higher payments than those who provide efficient, high-quality medicine." In addition, the Post reports that there are "striking variations" in the amount Medicare pays for care in different states, and "most high-spending states rank near the bottom in quality of care." For example, Louisiana ranked 50th in quality of care but first in Medicare spending for 2001. Overall, Medicare invests the equivalent of $1 to $2 in improvement and oversight of patient care for every $1,000 it pays to hospitals and other providers, the Post reports (Gaul , Washington Post, 7/24).
- "Early Deals Set the Stage for Today's Problems": Although Medicare is in "many ways ... one of the federal government's enduring successes," the program's standards of care have failed to keep up with medical innovation, the Post reports. Attempts to update the standards "have often become bogged down in politics and bureaucracy," according to the Post (Gaul , Washington Post, 7/24).
- "When Geography Influences Treatment Options": Physicians' approaches to treatment options for Medicare beneficiaries vary in different regions of the country and even within states, the Post reports. For example, in Fort Myers, Fla., Medicare beneficiaries underwent spinal surgery at a rate of 6.9 per 1,000 patients in 2001, compared with a rate of 3.2 in Miami, and 4.5 nationally. Medicare reimbursements, patient demand, diagnostic capabilities and physician preference all might play a factor in differing approaches to treatment (Gaul , Washington Post, 7/24).
- "Accreditors Blamed for Overlooking Problems": At the time of Medicare's creation in 1965, Congress charged JCAHO with evaluating hospitals and determining if standards of eligibility are met. According to the Post, JCAHO's methods "raise questions about potential conflicts of interest and the rigor of its hospital surveys." The Post notes that the organization operates a "thriving subsidiary that charges hospitals thousands of dollars for coaching on how to pass its reviews." In addition, JCAHO -- which awards accreditation to about 99% of the hospitals it evaluates -- has "missed glaring examples of poor care in which patients have been injured or killed," the Post reports (Gaul , Washington Post, 7/25).
- "At California Hospital, Red Flags and an FBI Raid": The FBI in October 2002 raided California's Tenet Healthcare-owned Redding Medical Center -- now called Shasta Regional Medical Center -- searching for evidence that doctors at the facility were "performing unnecessary tests and heart surgery on healthy patients," according to the Post. Following the raid, several government investigations were opened and hundreds of former patients filed lawsuits alleging unnecessary care. According to the Post, there were "warning signs ... for years" that were "missed by regulators and accrediting organizations" in what "turned out to be one of the nation's worst examples of overzealous medicine" (Gaul , Washington Post, 7/25).
- "Lack of Funds Reduces Frequency of Health Inspections": Quality inspections of outpatient surgery centers, kidney dialysis centers and other health care facilities by state health inspectors are performed infrequently, the Post reports. States "rely on Medicare for most of the money they use to monitor hospitals and other health facilities. And those funds are limited," according to the Post. While nursing homes must be inspected annually, surgical centers are required to be inspected only once every six years under federal rules. Some state inspection officials say they are unable to meet even the minimum requirements because too little funding from Medicare is committed to inspections (Gaul , Washington Post, 7/25).