Entries for August 2007

Excess weight is shed not all at once but ounce by painful ounce. Today's cars are more fuel efficient not because of one or two breakthroughs but because of the sum of many small improvements. And so, too, as I was reminded by a new study, is healthcare made better and safer—more by looking for small and simple steps, preferably obvious ones, than by seeking a few radical changes. The case in point: medical abbreviations.

You're unlikely to be surprised to hear that hospitals are routinely paid for indifferent or bad care, but did you know that it is implicitly built into the Medicare system? Say a Medicare patient is admitted for surgery, develops an infection because of sloppy post-surgical care, and has to stay several days longer than expected. The hospital will be reimbursed for at least some of the expenses due to its own failings.

This is because the infection is considered a complication under current Medicare rules, and hospitals are paid for treating complications. One way is for the complication to be recoded into a higher-reimbursement category. The other is that hospitals get back 80 percent of the amount above a threshold that changes every year (it's $24,485 for 2007). So if the infection generates extra costs of $75,000 (which isn't difficult these days), the hospital eats the first $24,485 but gets back 80 percent of the remaining $50,515, or more than $40,000. That's how it's been for decades. Is that crazy or what?

I know I'm as annoying as the screech of a knife on a plate when I rattle on interminably about numbers numbers numbers why don't we have the numbers? But whether the subject is No Child Left Behind or the longevity of household appliances or the rate of hospital infections, nothing can improve unless you know where you are now. That requires data.

I'm still ungritting my teeth and untensing my body (is that a word?) after last week's Food and Drug Administration hearings about risks that might or might not be posed by the diabetes drug Avandia. If you skipped over the news coverage because diabetes isn't an issue for you or your family, the point I want to make today is that whether it's Avandia for diabetes or some other drug taken for some other chronic condition, the bottom line is that there's no bottom line.