Doctors battle proposed penalties for heavy use of tests

"Doctors are trying to remove a provision in the Senate's latest health bill that would cut Medicare payments to those who administer the most tests and treatments," The Wall Street Journal reports. "The proposal -- aimed at reducing waste -- is one of several proposals in the bill by the Senate Finance Committee that could change how doctors are evaluated and paid."

One concern is that the provision would discourage doctors from accepting the sickest and oldest patients. "The bill calls for the secretary of Health and Human Services to account for doctors with less-healthy patients. But the government has acknowledged that its efforts to collect that type of data haven't fully accounted for all the attributes of Medicare recipients."

The bill would require that the HHS secretary send reports to doctors that compares their levels of treatment to other doctors. "Any doctor whose level of testing and procedures ranked at the 90th percentile or above would be penalized with 5% reductions in Medicare reimbursements. The bill also calls for doctors to submit data to the government designed to measure the quality of their treatment" (Adamy, 10/2).

A health blog post also from the Wall Street Journal reports on whether hospitals should penalize doctors who violate patient safety rules, a solution proposed in a New England Journal of Medicine article. The authors, both doctors, "contend that the failure to hold clinicians accountable for patient safety is the main reason health care is still riddled with errors, adverse events, and just plain non-adherence to some of the most basic rules. (Compliance with hand hygiene rules ranges from 30% to 70% at most hospitals, and few have sustained rates over 80%, the authors note, while there are about 4,000 wrong-site surgeries in the U.S. annually despite a universally accepted protocol for preventing them)."

Currently, "many hospitals have embraced a 'no blame' model: Instead of focusing on a single individual to blame for a mistake, they've tried to set up systems to prevent mistakes, catch them before they cause harm, or mitigate harm from errors that do reach patients." But the blog notes that the NEJM article recommends that doctors and nurses "who fail to follow rules about hand hygiene or patient handoffs should lose their privileges for a week." The New England Journal also recommended that surgeons lose their privileges for two weeks if they fail to have a "'time-out' before surgery or don't mark the surgical site to prevent wrong-site surgery" (Landro, 10/1).