“As you might expect, Julie, as a senior citizen many of my
friends are also senior citizens.
And as a volunteer in health care, my senior citizen friends tend to
share with me their poor health care outcomes.”
“Curmudge, I recall that some of those outcomes have
occurred pretty close to home, like your college roommate in Stan’s
Story and Ms. Curmudgeon in A
Day in a Hospital in Prague. “
“As it turned out, my wife’s problems weren’t over when she
returned home. The fall in Prague
had torn her rotator cuff, which now needed surgical repair.”
“Clear the track!
I think another medical anecdote is headed our way.”
“After waiting several weeks to get on the doc’s schedule,
my wife went in for arthroscopic surgery on her right shoulder. Regrettably, the screws (or whatever)
were observed to pull out, so the doc had to finish the job via open
surgery. After several weeks of
therapy, an MRI revealed that the results of the open surgery hadn’t held,
either.”
“What a bummer!
So Ms. Curmudgeon couldn’t raise her right arm all the way. That’s quite a disability for a
professional organist and choir director.”
“I found it interesting, Julie, that the Medicare Summary
Notice showed two CPT (Current Procedure Terminology) codes for my wife’s
rotator cuff surgery. One was for
the arthroscopic surgery and one for the open surgery, neither of which was
successful. If it weren’t for the
two CPT codes, it wouldn’t have caught my eye. It would appear that the doc was paid the same, irrespective
of the outcome.”
“That’s the system, Curmudge. Outcomes are not factored into reimbursements. And because Ms. Curmudgeon was covered
by Medicare, the citizens of the United States paid for two unsuccessful
surgeries. As we quoted Dr.
Groopman in an earlier posting, ‘No
one can guarantee the right outcome from a treatment for an individual
patient.’ ”
“I guess that’s one
reason why reimbursement systems based on outcomes are problematic. One would think that qualifiers might
at least be added to the bill…perhaps an ‘attaboy’ for a success and ‘oops’ for
an obvious failure.”
“No physician can
afford too many ‘oopses,’ Curmudge.
As you said earlier, patients—especially senior citizens—don’t hesitate
to talk about their health care experiences.”
“The surgeon put in a full morning’s work and was paid for
his efforts, but he was probably as frustrated as we were. Perhaps the shoulder was truly beyond
repair. This was a story with no
happy ending for anyone.”
“Paying for procedures and not outcomes is one of those
ongoing problems in today’s health care.
My guess, Curmudge, is that we will discuss this further.”
Kaizen Curmudgeon
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