It was hard to keep from cringing as I leafed through the results of a physician survey centering on quality of care. They were just released by the American College of Physician Executives, whose members consist mostly of doctors with management responsibilities.
A couple of telling questions physicians were asked: Does your hospital or group practice put up with subpar care from doctors or departments whose work is important to the financial bottom line? Yes, said nearly 40 percent of the 1,155 physicians surveyed. Is the main focus on patients or on cost when decisions affecting quality and safety are made? Mostly on cost, said 33 percent. On and on went the distressing report from the front lines.
Invited to submit additional opinions, the docs vented. Did they ever! The ACPE says it received more than 2,000 comments.
One physician complained about an excessive volume of $50,000 to $60,000 spinal fusion surgeries for relief of lower-back pain–600 percent higher than the national average–"without evidence that it offers any advantage over conservative care." Another cited a high-volume interventional cardiologist whose judgment is routinely questionable. "All in administration acknowledge this but do not 'rock the boat,'" the respondent wrote.
Because of overcrowding, patients treated in the emergency department are often held there for up to two days before beds come free, charged a third. And there was this heart-stopping message: "We really need to upgrade our defibrillators for safety reasons, but due to finances this was nixed."
There are times I'd almost rather not hear about what goes on behind the scenes. But without understanding the true nature of the problems that get in the way of improved patient care and safety, we won't know how to make them go away, will we?
U.S. News's Avery Comarow has been editor of the America's Best Hospitals annual rankings since they first appeared in 1990. His reporting on clinical medicine, from the latest cholesterol guidelines to robotic surgery, has been driven by the question: What does this mean to patients? And that is the perspective he brings to his observations and commentaries on the increasing number of programs by hospitals and other healthcare providers to improve care and patient safety.
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