Correction:  EVERYONE (hospital administration, coworkers, and the surgeon
who comes out in the middle of the night) will criticize a physician who
perforates colons a rate higher than what should realistically be expected.

If gastroenterologists had to pay out of pocket for the expenses of every
ruptured colon (let's say 1 in 100 or so, but I'm honestly not up to date on
the current perf rate) then they and all other MD's would cease to do
colonoscopies except in medical emergencies.

If I had to pay for all incontinence surgery after a prostatectomy (about
2-5% will have urinary leakage after surgery and require some sort of
procedure to correct that) I would stop doing them tomorrow and never even
consider doing one again.

In medicine there are known adverse events of surgery/procedures.  We do our
best to minimize them.  I agree we can and should do more.  But the
cowboy/ignorant attitude of "well, just have the doctor pay the subsequent
medical costs" is not a solution - it's a childish knee jerk reaction that
has no basis in reality.

"George Conklin" <nil@earthlink.net> wrote in message
news:13s086gouc41lec@corp.supernews.com...

"Skeptic" <bcs002b@yahoo.com> wrote in message
news:44Avj.44787$9j6.36928@attbi_s22...

"George Conklin" <nil@earthlink.net> wrote in message
news:13rs71j4tt7qibc@corp.supernews.com...

"D. C. Sessions" <dcs@lumbercartel.com> wrote in message
news:9qa195-n3h.ln1@news.lumbercartel.com...
In message <13rrsrii43e7qf5@corp.supernews.com>, George Conklin
wrote:
"Skeptic" <bcs002b@yahoo.com> wrote in message
news:Sg6vj.42739$9j6.31268@attbi_s22...

I don't see that. Substandard care can result in medical
complications.
Medical complications are costly to fix and can be devastating to
a
physician's credibiltiy. A commonly used example is the
gastroenterologist
perforating a colon and making money on the surgical repair.
People
that
make those sorts of claims simply do not understand that the
doctor
repairing the colon will be a busy general surgeon who was not
involved
in
the case and now has to cancel his clinic or come in in the
middle
of
the
night for an urgent surgery. The GI doc who perforated gets
nothing
except
scrutiny.

This happened to our departmental secretary. She was a lady
who
weighted exactly the ideal weight for her height, and after the
surgery
to
repair the perforation, looked 5-6 months pregnant for about 1
year.
She
lost 6 weeks of work, and got billed about $35,000 for the
"repair."
Errors
are highly profitable to the system.

NB, the "system" here includes more than the two MDs listed,
although (like quarterbacks) they're the ones who get the
attention. Whether the MD who was on watch for the original
problem was the one who ended up submitting a bill for the
repair or not, and regardless of "blame," the /hospital/
takes incidents like this as revenue.

Now look at the list of items headed for noncompensation and
appreciate that a lot of them are in the "team effort" group.
Sponge miscounts, for instance. "Command responsibility" or
not, it is _not_ the surgeon who is supposed to be keeping
personal track of each sponge, and if I ever find out that
a surgeon planning to work on me /does/, I'm getting someone
else -- I want his attention on other things.

Instead, that sponge count is (IIRC) the responsibility of
an OR nurse who may well be working on her 12th hour on her
feet in a schedule that has her working both night and day
shifts (cost cutting, remember) and regardless of overtime
regs she hasn't had 24 hours straight off for six days.
Which might not be so bad except as another cost-cutting
measure the staffing has been cut back so that her workload
is more than she normally could keep track of anyway even
if she hadn't missed lunchbreak to catch up on paperwork and
is running low on blood sugar.

Hey, it saves on health care costs, right?

So keep in mind that since individual patients simply don't
have any negotiating power, and since the cost of running
a Board of Inquiry on every adverse outcome is prohibitive,
it may well be that pushing the cost of (at least some)
nonquality onto the caregivers *may* be the best shot that
MDs have for getting adequate support -- who aren't dead
on their feet.

The patient never knows who is responsible and will never be able to
find
out. But the bill must be paid in all cases, and insurance companies
have
no problem paying for errors. And hospitals have little incentive
for
lowering error rates as long as it results in more profitable
business.

Oh, come on - if your colon is perforated you know exactly was
responsible.
Should that doctor be forced to cover the ensuing hospital expenses?
Of
course not.

Of course not? Fixing errors is part of the cost of doing business
in
all other fields. If the mechanic ruins your car, the dealer's
insurance
from the dealer covers that. If a doctor ruptures a colon, he states
he/she
is not responsible but you are. Medicine is still based on the
small-business model of 1900, but there used to be personal
responsibility
what went with that model.

If gastroenterologists had to pay out of pocket for the expenses of every
ruptured colon (let's say 1 in 100 or so, but I'm honestly not up to date
on
the current perf rate) then they and all other MD's would cease to do
colonoscopies except in medical emergencies.

If I had to pay for all incontinence surgery after a prostatectomy (about
2-5% will have urinary leakage after surgery and require some sort of
procedure to correct that) I would stop doing them tomorrow and never even
consider doing one again.

In medicine there are known adverse events of surgery/procedures. We do
our
best to minimize them. I agree we can and should do more. But the
cowboy/ignorant attitude of "well, just have the doctor pay the subsequent
medical costs" is not a solution - it's a childish knee jerk reaction that
has no basis in reality.

"George Conklin" <nil@earthlink.net> wrote in message
news:13s08bme106h22c@corp.supernews.com...

"Skeptic" <bcs002b@yahoo.com> wrote in message
news:y2Avj.45039$yE1.35563@attbi_s21...

"George Conklin" <nil@earthlink.net> wrote in message
news:13rrsrii43e7qf5@corp.supernews.com...

"Skeptic" <bcs002b@yahoo.com> wrote in message
news:Sg6vj.42739$9j6.31268@attbi_s22...

"D. C. Sessions" <dcs@lumbercartel.com> wrote in message
news:jkpt85-1oi.ln1@news.lumbercartel.com...
In message <xMMuj.41516$yE1.27616@attbi_s21>, Skeptic wrote:
"Ilena Rose" <BIA@mundo.com> wrote in message
news:e02mr31mvnkggh68o0rjdra44sde0phlnm@4ax.com...

WASHINGTON - It's a new way to push for patient safety: Don't
pay
hospitals for their errors.

Beginning Oct. 1, Medicare no longer will cover extra-care costs
for
eight preventable hospital errors. Nor can hospitals bill the
injured
patient for those extra costs.

"Money talks," says Dr. Steven Gordon, infectious disease chief
at
the
Cleveland Clinic Foundation. "Every hospital CFO, this gets
their
attention."

- - -

Medicare's targets

*Urinary tract infections from catheters

This is old news. This is also one of the biggest reasons we
should
be
very
fearful of a government run healthcare system. UTI's are an
absolutely
unavoidable outcome in a percentage of patients with catheters in
place.
The people that come up with this insanity simply don't have a
clue.

Is it possible to prevent every last single catheter infection?
(Aside from never using catheters, anyway) No, of course not.
Is the alternative to give care providers carte blanche to be
paid for bad patient outcomes regardless of substandard care?
One would hope not. Is the alternative to require the equivalent
of a Board of Inquiry on every nosocomial infection? Not cost-
effective.

If we take all of this out of the "blame" space and put it in
a "quality improvement" space, though, you get a different
perspective. The current incentive structure, frankly, is a
"cost plus" system where providers have a financial incentive
to provide substandard care which, when it causes adverse
patient outcomes, *increases* their revenues.

I don't see that. Substandard care can result in medical
complications.
Medical complications are costly to fix and can be devastating to a
physician's credibiltiy. A commonly used example is the
gastroenterologist
perforating a colon and making money on the surgical repair. People
that
make those sorts of claims simply do not understand that the doctor
repairing the colon will be a busy general surgeon who was not
involved
in
the case and now has to cancel his clinic or come in in the middle
of
the
night for an urgent surgery. The GI doc who perforated gets nothing
except
scrutiny.

This happened to our departmental secretary. She was a lady who
weighted exactly the ideal weight for her height, and after the
surgery
to
repair the perforation, looked 5-6 months pregnant for about 1 year.
She
lost 6 weeks of work, and got billed about $35,000 for the "repair."
Errors
are highly profitable to the system.

But not to the people who make them.


The system is what supports the current practices and no one is going
to
criticize a physician who gives them a lot of profitable referrals.

Correction: EVERYONE (hospital administration, coworkers, and the surgeon
who comes out in the middle of the night) will criticize a physician who
perforates colons a rate higher than what should realistically be
expected.

"Skeptic" <bcs002b@yahoo.com> wrote in message
news:1KVvj.46453$yE1.7648@attbi_s21...

"George Conklin" <nil@earthlink.net> wrote in message
news:13s086gouc41lec@corp.supernews.com...

"Skeptic" <bcs002b@yahoo.com> wrote in message
news:44Avj.44787$9j6.36928@attbi_s22...

"George Conklin" <nil@earthlink.net> wrote in message
news:13rs71j4tt7qibc@corp.supernews.com...

"D. C. Sessions" <dcs@lumbercartel.com> wrote in message
news:9qa195-n3h.ln1@news.lumbercartel.com...
In message <13rrsrii43e7qf5@corp.supernews.com>, George Conklin
wrote:
"Skeptic" <bcs002b@yahoo.com> wrote in message
news:Sg6vj.42739$9j6.31268@attbi_s22...

I don't see that. Substandard care can result in medical
complications.
Medical complications are costly to fix and can be devastating
to
a
physician's credibiltiy. A commonly used example is the
gastroenterologist
perforating a colon and making money on the surgical repair.
People
that
make those sorts of claims simply do not understand that the
doctor
repairing the colon will be a busy general surgeon who was not
involved
in
the case and now has to cancel his clinic or come in in the
middle
of
the
night for an urgent surgery. The GI doc who perforated gets
nothing
except
scrutiny.

This happened to our departmental secretary. She was a lady
who
weighted exactly the ideal weight for her height, and after the
surgery
to
repair the perforation, looked 5-6 months pregnant for about 1
year.
She
lost 6 weeks of work, and got billed about $35,000 for the
"repair."
Errors
are highly profitable to the system.

NB, the "system" here includes more than the two MDs listed,
although (like quarterbacks) they're the ones who get the
attention. Whether the MD who was on watch for the original
problem was the one who ended up submitting a bill for the
repair or not, and regardless of "blame," the /hospital/
takes incidents like this as revenue.

Now look at the list of items headed for noncompensation and
appreciate that a lot of them are in the "team effort" group.
Sponge miscounts, for instance. "Command responsibility" or
not, it is _not_ the surgeon who is supposed to be keeping
personal track of each sponge, and if I ever find out that
a surgeon planning to work on me /does/, I'm getting someone
else -- I want his attention on other things.

Instead, that sponge count is (IIRC) the responsibility of
an OR nurse who may well be working on her 12th hour on her
feet in a schedule that has her working both night and day
shifts (cost cutting, remember) and regardless of overtime
regs she hasn't had 24 hours straight off for six days.
Which might not be so bad except as another cost-cutting
measure the staffing has been cut back so that her workload
is more than she normally could keep track of anyway even
if she hadn't missed lunchbreak to catch up on paperwork and
is running low on blood sugar.

Hey, it saves on health care costs, right?

So keep in mind that since individual patients simply don't
have any negotiating power, and since the cost of running
a Board of Inquiry on every adverse outcome is prohibitive,
it may well be that pushing the cost of (at least some)
nonquality onto the caregivers *may* be the best shot that
MDs have for getting adequate support -- who aren't dead
on their feet.

The patient never knows who is responsible and will never be able
to
find
out. But the bill must be paid in all cases, and insurance
companies
have
no problem paying for errors. And hospitals have little incentive
for
lowering error rates as long as it results in more profitable
business.

Oh, come on - if your colon is perforated you know exactly was
responsible.
Should that doctor be forced to cover the ensuing hospital expenses?
Of
course not.

Of course not? Fixing errors is part of the cost of doing business
in
all other fields. If the mechanic ruins your car, the dealer's
insurance
from the dealer covers that. If a doctor ruptures a colon, he states
he/she
is not responsible but you are. Medicine is still based on the
small-business model of 1900, but there used to be personal
responsibility
what went with that model.

If gastroenterologists had to pay out of pocket for the expenses of every
ruptured colon (let's say 1 in 100 or so, but I'm honestly not up to date
on
the current perf rate) then they and all other MD's would cease to do
colonoscopies except in medical emergencies.

No, the rate for the other 99 would be a few percent higher to cover the
cost of fixing up failures. You always think of personal costs, not
system
costs. That is the 1900 small business model. Medicine to day is a vast
system.



If I had to pay for all incontinence surgery after a prostatectomy (about
2-5% will have urinary leakage after surgery and require some sort of
procedure to correct that) I would stop doing them tomorrow and never
even
consider doing one again.


Cancer surgery is not the same as elective tests. No one claimed they
are.



In medicine there are known adverse events of surgery/procedures. We do
our
best to minimize them. I agree we can and should do more. But the
cowboy/ignorant attitude of "well, just have the doctor pay the
subsequent
medical costs" is not a solution - it's a childish knee jerk reaction
that
has no basis in reality.

Again, elective tests pushed by the establishment are not the same as
cancer surgery.

"Skeptic" <bcs002b@yahoo.com> wrote in message
news:WNVvj.46458$yE1.30432@attbi_s21...

"George Conklin" <nil@earthlink.net> wrote in message
news:13s08bme106h22c@corp.supernews.com...

"Skeptic" <bcs002b@yahoo.com> wrote in message
news:y2Avj.45039$yE1.35563@attbi_s21...

"George Conklin" <nil@earthlink.net> wrote in message
news:13rrsrii43e7qf5@corp.supernews.com...

"Skeptic" <bcs002b@yahoo.com> wrote in message
news:Sg6vj.42739$9j6.31268@attbi_s22...

"D. C. Sessions" <dcs@lumbercartel.com> wrote in message
news:jkpt85-1oi.ln1@news.lumbercartel.com...
In message <xMMuj.41516$yE1.27616@attbi_s21>, Skeptic wrote:
"Ilena Rose" <BIA@mundo.com> wrote in message
news:e02mr31mvnkggh68o0rjdra44sde0phlnm@4ax.com...

WASHINGTON - It's a new way to push for patient safety: Don't
pay
hospitals for their errors.

Beginning Oct. 1, Medicare no longer will cover extra-care
costs
for
eight preventable hospital errors. Nor can hospitals bill the
injured
patient for those extra costs.

"Money talks," says Dr. Steven Gordon, infectious disease chief
at
the
Cleveland Clinic Foundation. "Every hospital CFO, this gets
their
attention."

- - -

Medicare's targets

*Urinary tract infections from catheters

This is old news. This is also one of the biggest reasons we
should
be
very
fearful of a government run healthcare system. UTI's are an
absolutely
unavoidable outcome in a percentage of patients with catheters
in
place.
The people that come up with this insanity simply don't have a
clue.

Is it possible to prevent every last single catheter infection?
(Aside from never using catheters, anyway) No, of course not.
Is the alternative to give care providers carte blanche to be
paid for bad patient outcomes regardless of substandard care?
One would hope not. Is the alternative to require the equivalent
of a Board of Inquiry on every nosocomial infection? Not cost-
effective.

If we take all of this out of the "blame" space and put it in
a "quality improvement" space, though, you get a different
perspective. The current incentive structure, frankly, is a
"cost plus" system where providers have a financial incentive
to provide substandard care which, when it causes adverse
patient outcomes, *increases* their revenues.

I don't see that. Substandard care can result in medical
complications.
Medical complications are costly to fix and can be devastating to a
physician's credibiltiy. A commonly used example is the
gastroenterologist
perforating a colon and making money on the surgical repair.
People
that
make those sorts of claims simply do not understand that the doctor
repairing the colon will be a busy general surgeon who was not
involved
in
the case and now has to cancel his clinic or come in in the middle
of
the
night for an urgent surgery. The GI doc who perforated gets
nothing
except
scrutiny.

This happened to our departmental secretary. She was a lady who
weighted exactly the ideal weight for her height, and after the
surgery
to
repair the perforation, looked 5-6 months pregnant for about 1 year.
She
lost 6 weeks of work, and got billed about $35,000 for the "repair."
Errors
are highly profitable to the system.

But not to the people who make them.


The system is what supports the current practices and no one is
going
to
criticize a physician who gives them a lot of profitable referrals.

Correction: EVERYONE (hospital administration, coworkers, and the
surgeon
who comes out in the middle of the night) will criticize a physician who
perforates colons a rate higher than what should realistically be
expected.



Everyone except the patient, who is never allowed to know who the bad
players are.

And does anyone really keep track of the physician who
perforates colons at the higher rate than expected?

Is that data every
systematically collected? Who would ever know? It is kept secret to
protect the system.

I'll be perfectly honest - yes and no.  Since there is not one "correct"
perforation rate and since such events are rare, it would hard to measure
accurately.  That's the "no" part.  The "yes" part is if there is an obvious
trend ... example 3 of the last 10 ended up colostomies - that would noticed
by the department head, hospital administrator, and the general surgery
department.

"George Conklin" <nil@earthlink.net> wrote in message
news:13s14d5ccio6ob4@corp.supernews.com...

"Skeptic" <bcs002b@yahoo.com> wrote in message
news:1KVvj.46453$yE1.7648@attbi_s21...

"George Conklin" <nil@earthlink.net> wrote in message
news:13s086gouc41lec@corp.supernews.com...

"Skeptic" <bcs002b@yahoo.com> wrote in message
news:44Avj.44787$9j6.36928@attbi_s22...

"George Conklin" <nil@earthlink.net> wrote in message
news:13rs71j4tt7qibc@corp.supernews.com...

"D. C. Sessions" <dcs@lumbercartel.com> wrote in message
news:9qa195-n3h.ln1@news.lumbercartel.com...
In message <13rrsrii43e7qf5@corp.supernews.com>, George Conklin
wrote:
"Skeptic" <bcs002b@yahoo.com> wrote in message
news:Sg6vj.42739$9j6.31268@attbi_s22...

I don't see that. Substandard care can result in medical
complications.
Medical complications are costly to fix and can be devastating
to
a
physician's credibiltiy. A commonly used example is the
gastroenterologist
perforating a colon and making money on the surgical repair.
People
that
make those sorts of claims simply do not understand that the
doctor
repairing the colon will be a busy general surgeon who was not
involved
in
the case and now has to cancel his clinic or come in in the
middle
of
the
night for an urgent surgery. The GI doc who perforated gets
nothing
except
scrutiny.

This happened to our departmental secretary. She was a
lady
who
weighted exactly the ideal weight for her height, and after the
surgery
to
repair the perforation, looked 5-6 months pregnant for about 1
year.
She
lost 6 weeks of work, and got billed about $35,000 for the
"repair."
Errors
are highly profitable to the system.

NB, the "system" here includes more than the two MDs listed,
although (like quarterbacks) they're the ones who get the
attention. Whether the MD who was on watch for the original
problem was the one who ended up submitting a bill for the
repair or not, and regardless of "blame," the /hospital/
takes incidents like this as revenue.

Now look at the list of items headed for noncompensation and
appreciate that a lot of them are in the "team effort" group.
Sponge miscounts, for instance. "Command responsibility" or
not, it is _not_ the surgeon who is supposed to be keeping
personal track of each sponge, and if I ever find out that
a surgeon planning to work on me /does/, I'm getting someone
else -- I want his attention on other things.

Instead, that sponge count is (IIRC) the responsibility of
an OR nurse who may well be working on her 12th hour on her
feet in a schedule that has her working both night and day
shifts (cost cutting, remember) and regardless of overtime
regs she hasn't had 24 hours straight off for six days.
Which might not be so bad except as another cost-cutting
measure the staffing has been cut back so that her workload
is more than she normally could keep track of anyway even
if she hadn't missed lunchbreak to catch up on paperwork and
is running low on blood sugar.

Hey, it saves on health care costs, right?

So keep in mind that since individual patients simply don't
have any negotiating power, and since the cost of running
a Board of Inquiry on every adverse outcome is prohibitive,
it may well be that pushing the cost of (at least some)
nonquality onto the caregivers *may* be the best shot that
MDs have for getting adequate support -- who aren't dead
on their feet.

The patient never knows who is responsible and will never be able
to
find
out. But the bill must be paid in all cases, and insurance
companies
have
no problem paying for errors. And hospitals have little incentive
for
lowering error rates as long as it results in more profitable
business.

Oh, come on - if your colon is perforated you know exactly was
responsible.
Should that doctor be forced to cover the ensuing hospital expenses?
Of
course not.

Of course not? Fixing errors is part of the cost of doing
business
in
all other fields. If the mechanic ruins your car, the dealer's
insurance
from the dealer covers that. If a doctor ruptures a colon, he states
he/she
is not responsible but you are. Medicine is still based on the
small-business model of 1900, but there used to be personal
responsibility
what went with that model.

If gastroenterologists had to pay out of pocket for the expenses of
every
ruptured colon (let's say 1 in 100 or so, but I'm honestly not up to
date
on
the current perf rate) then they and all other MD's would cease to do
colonoscopies except in medical emergencies.

No, the rate for the other 99 would be a few percent higher to cover
the
cost of fixing up failures. You always think of personal costs, not
system
costs. That is the 1900 small business model. Medicine to day is a
vast
system.



If I had to pay for all incontinence surgery after a prostatectomy
(about
2-5% will have urinary leakage after surgery and require some sort of
procedure to correct that) I would stop doing them tomorrow and never
even
consider doing one again.


Cancer surgery is not the same as elective tests. No one claimed
they
are.



In medicine there are known adverse events of surgery/procedures. We
do
our
best to minimize them. I agree we can and should do more. But the
cowboy/ignorant attitude of "well, just have the doctor pay the
subsequent
medical costs" is not a solution - it's a childish knee jerk reaction
that
has no basis in reality.

Again, elective tests pushed by the establishment are not the same as
cancer surgery.

Ok.

What sort of elective tests are we talking about?

"George Conklin" <nil@earthlink.net> wrote in message
news:13s14g5dcu5443d@corp.supernews.com...

"Skeptic" <bcs002b@yahoo.com> wrote in message
news:WNVvj.46458$yE1.30432@attbi_s21...

"George Conklin" <nil@earthlink.net> wrote in message
news:13s08bme106h22c@corp.supernews.com...

"Skeptic" <bcs002b@yahoo.com> wrote in message
news:y2Avj.45039$yE1.35563@attbi_s21...

"George Conklin" <nil@earthlink.net> wrote in message
news:13rrsrii43e7qf5@corp.supernews.com...

"Skeptic" <bcs002b@yahoo.com> wrote in message
news:Sg6vj.42739$9j6.31268@attbi_s22...

"D. C. Sessions" <dcs@lumbercartel.com> wrote in message
news:jkpt85-1oi.ln1@news.lumbercartel.com...
In message <xMMuj.41516$yE1.27616@attbi_s21>, Skeptic wrote:
"Ilena Rose" <BIA@mundo.com> wrote in message
news:e02mr31mvnkggh68o0rjdra44sde0phlnm@4ax.com...

WASHINGTON - It's a new way to push for patient safety: Don't
pay
hospitals for their errors.

Beginning Oct. 1, Medicare no longer will cover extra-care
costs
for
eight preventable hospital errors. Nor can hospitals bill the
injured
patient for those extra costs.

"Money talks," says Dr. Steven Gordon, infectious disease
chief
at
the
Cleveland Clinic Foundation. "Every hospital CFO, this gets
their
attention."

- - -

Medicare's targets

*Urinary tract infections from catheters

This is old news. This is also one of the biggest reasons we
should
be
very
fearful of a government run healthcare system. UTI's are an
absolutely
unavoidable outcome in a percentage of patients with catheters
in
place.
The people that come up with this insanity simply don't have a
clue.

Is it possible to prevent every last single catheter infection?
(Aside from never using catheters, anyway) No, of course not.
Is the alternative to give care providers carte blanche to be
paid for bad patient outcomes regardless of substandard care?
One would hope not. Is the alternative to require the
equivalent
of a Board of Inquiry on every nosocomial infection? Not cost-
effective.

If we take all of this out of the "blame" space and put it in
a "quality improvement" space, though, you get a different
perspective. The current incentive structure, frankly, is a
"cost plus" system where providers have a financial incentive
to provide substandard care which, when it causes adverse
patient outcomes, *increases* their revenues.

I don't see that. Substandard care can result in medical
complications.
Medical complications are costly to fix and can be devastating to
a
physician's credibiltiy. A commonly used example is the
gastroenterologist
perforating a colon and making money on the surgical repair.
People
that
make those sorts of claims simply do not understand that the
doctor
repairing the colon will be a busy general surgeon who was not
involved
in
the case and now has to cancel his clinic or come in in the
middle
of
the
night for an urgent surgery. The GI doc who perforated gets
nothing
except
scrutiny.

This happened to our departmental secretary. She was a lady
who
weighted exactly the ideal weight for her height, and after the
surgery
to
repair the perforation, looked 5-6 months pregnant for about 1
year.
She
lost 6 weeks of work, and got billed about $35,000 for the
"repair."
Errors
are highly profitable to the system.

But not to the people who make them.


The system is what supports the current practices and no one is
going
to
criticize a physician who gives them a lot of profitable referrals.

Correction: EVERYONE (hospital administration, coworkers, and the
surgeon
who comes out in the middle of the night) will criticize a physician
who
perforates colons a rate higher than what should realistically be
expected.



Everyone except the patient, who is never allowed to know who the bad
players are.

A patient in for a routine colonoscopy meets the doctor beforehand,
discusses the procedure, etc. If there is ever a perforation or some
other
problem, they know exactly who to come looking for.

And does anyone really keep track of the physician who
perforates colons at the higher rate than expected?

I'll be perfectly honest - yes and no. Since there is not one "correct"
perforation rate and since such events are rare, it would hard to measure
accurately.

trend ... example 3 of the last 10 ended up colostomies - that would
noticed
by the department head, hospital administrator, and the general surgery
department.

Is that data every
systematically collected? Who would ever know? It is kept secret to
protect the system.

Who do you think should have access to such information?

"Skeptic" <bcs002b@yahoo.com> wrote in message
news:Pp1wj.47029$yE1.44171@attbi_s21...

"George Conklin" <nil@earthlink.net> wrote in message
news:13s14g5dcu5443d@corp.supernews.com...

"Skeptic" <bcs002b@yahoo.com> wrote in message
news:WNVvj.46458$yE1.30432@attbi_s21...

"George Conklin" <nil@earthlink.net> wrote in message
news:13s08bme106h22c@corp.supernews.com...

"Skeptic" <bcs002b@yahoo.com> wrote in message
news:y2Avj.45039$yE1.35563@attbi_s21...

"George Conklin" <nil@earthlink.net> wrote in message
news:13rrsrii43e7qf5@corp.supernews.com...

"Skeptic" <bcs002b@yahoo.com> wrote in message
news:Sg6vj.42739$9j6.31268@attbi_s22...

"D. C. Sessions" <dcs@lumbercartel.com> wrote in message
news:jkpt85-1oi.ln1@news.lumbercartel.com...
In message <xMMuj.41516$yE1.27616@attbi_s21>, Skeptic wrote:
"Ilena Rose" <BIA@mundo.com> wrote in message
news:e02mr31mvnkggh68o0rjdra44sde0phlnm@4ax.com...

WASHINGTON - It's a new way to push for patient safety:
Don't
pay
hospitals for their errors.

Beginning Oct. 1, Medicare no longer will cover extra-care
costs
for
eight preventable hospital errors. Nor can hospitals bill
the
injured
patient for those extra costs.

"Money talks," says Dr. Steven Gordon, infectious disease
chief
at
the
Cleveland Clinic Foundation. "Every hospital CFO, this gets
their
attention."

- - -

Medicare's targets

*Urinary tract infections from catheters

This is old news. This is also one of the biggest reasons we
should
be
very
fearful of a government run healthcare system. UTI's are an
absolutely
unavoidable outcome in a percentage of patients with
catheters
in
place.
The people that come up with this insanity simply don't have
a
clue.

Is it possible to prevent every last single catheter
infection?
(Aside from never using catheters, anyway) No, of course not.
Is the alternative to give care providers carte blanche to be
paid for bad patient outcomes regardless of substandard care?
One would hope not. Is the alternative to require the
equivalent
of a Board of Inquiry on every nosocomial infection? Not
cost-
effective.

If we take all of this out of the "blame" space and put it in
a "quality improvement" space, though, you get a different
perspective. The current incentive structure, frankly, is a
"cost plus" system where providers have a financial incentive
to provide substandard care which, when it causes adverse
patient outcomes, *increases* their revenues.

I don't see that. Substandard care can result in medical
complications.
Medical complications are costly to fix and can be devastating
to
a
physician's credibiltiy. A commonly used example is the
gastroenterologist
perforating a colon and making money on the surgical repair.
People
that
make those sorts of claims simply do not understand that the
doctor
repairing the colon will be a busy general surgeon who was not
involved
in
the case and now has to cancel his clinic or come in in the
middle
of
the
night for an urgent surgery. The GI doc who perforated gets
nothing
except
scrutiny.

This happened to our departmental secretary. She was a lady
who
weighted exactly the ideal weight for her height, and after the
surgery
to
repair the perforation, looked 5-6 months pregnant for about 1
year.
She
lost 6 weeks of work, and got billed about $35,000 for the
"repair."
Errors
are highly profitable to the system.

But not to the people who make them.


The system is what supports the current practices and no one is
going
to
criticize a physician who gives them a lot of profitable referrals.

Correction: EVERYONE (hospital administration, coworkers, and the
surgeon
who comes out in the middle of the night) will criticize a physician
who
perforates colons a rate higher than what should realistically be
expected.



Everyone except the patient, who is never allowed to know who the bad
players are.

A patient in for a routine colonoscopy meets the doctor beforehand,
discusses the procedure, etc. If there is ever a perforation or some
other
problem, they know exactly who to come looking for.

But the patient never knows who is the player with a high number of
ruptures. That is carefully hidden from the patient. You wrote "EVERYONE
(hospital administration, coworkers, and the surgeon who comes out in the
middle of the night)" knows...but never the patient. Greshams law applies
here.



And does anyone really keep track of the physician who
perforates colons at the higher rate than expected?

I'll be perfectly honest - yes and no. Since there is not one "correct"
perforation rate and since such events are rare, it would hard to measure
accurately.

You are engaging in mystification here. No one can know? You just got
done saying EVERYONE knows....know you say no one knows.


That's the "no" part. The "yes" part is if there is an obvious
trend ... example 3 of the last 10 ended up colostomies - that would
noticed
by the department head, hospital administrator, and the general surgery
department.

Is that data every
systematically collected? Who would ever know? It is kept secret to
protect the system.

Who do you think should have access to such information?

PATIENTS

"Skeptic" <bcs002b@yahoo.com> wrote in message
news:tk1wj.46821$9j6.5056@attbi_s22...

"George Conklin" <nil@earthlink.net> wrote in message
news:13s14d5ccio6ob4@corp.supernews.com...

Again, elective tests pushed by the establishment are not the same as
cancer surgery.

Ok.

What sort of elective tests are we talking about?



I thought the subject had been colonosocopy.

"George Conklin" <nil@earthlink.net> wrote in message
news:13s1dn2h2ln8t43@corp.supernews.com...

"Skeptic" <bcs002b@yahoo.com> wrote in message
news:Pp1wj.47029$yE1.44171@attbi_s21...

"George Conklin" <nil@earthlink.net> wrote in message
news:13s14g5dcu5443d@corp.supernews.com...

"Skeptic" <bcs002b@yahoo.com> wrote in message
news:WNVvj.46458$yE1.30432@attbi_s21...

"George Conklin" <nil@earthlink.net> wrote in message
news:13s08bme106h22c@corp.supernews.com...

"Skeptic" <bcs002b@yahoo.com> wrote in message
news:y2Avj.45039$yE1.35563@attbi_s21...

"George Conklin" <nil@earthlink.net> wrote in message
news:13rrsrii43e7qf5@corp.supernews.com...

"Skeptic" <bcs002b@yahoo.com> wrote in message
news:Sg6vj.42739$9j6.31268@attbi_s22...

"D. C. Sessions" <dcs@lumbercartel.com> wrote in message
news:jkpt85-1oi.ln1@news.lumbercartel.com...
In message <xMMuj.41516$yE1.27616@attbi_s21>, Skeptic wrote:
"Ilena Rose" <BIA@mundo.com> wrote in message
news:e02mr31mvnkggh68o0rjdra44sde0phlnm@4ax.com...

WASHINGTON - It's a new way to push for patient safety:
Don't
pay
hospitals for their errors.

Beginning Oct. 1, Medicare no longer will cover extra-care
costs
for
eight preventable hospital errors. Nor can hospitals bill
the
injured
patient for those extra costs.

"Money talks," says Dr. Steven Gordon, infectious disease
chief
at
the
Cleveland Clinic Foundation. "Every hospital CFO, this
gets
their
attention."

- - -

Medicare's targets

*Urinary tract infections from catheters

This is old news. This is also one of the biggest reasons
we
should
be
very
fearful of a government run healthcare system. UTI's are
an
absolutely
unavoidable outcome in a percentage of patients with
catheters
in
place.
The people that come up with this insanity simply don't
have
a
clue.

Is it possible to prevent every last single catheter
infection?
(Aside from never using catheters, anyway) No, of course
not.
Is the alternative to give care providers carte blanche to
be
paid for bad patient outcomes regardless of substandard
care?
One would hope not. Is the alternative to require the
equivalent
of a Board of Inquiry on every nosocomial infection? Not
cost-
effective.

If we take all of this out of the "blame" space and put it
in
a "quality improvement" space, though, you get a different
perspective. The current incentive structure, frankly, is a
"cost plus" system where providers have a financial
incentive
to provide substandard care which, when it causes adverse
patient outcomes, *increases* their revenues.

I don't see that. Substandard care can result in medical
complications.
Medical complications are costly to fix and can be devastating
to
a
physician's credibiltiy. A commonly used example is the
gastroenterologist
perforating a colon and making money on the surgical repair.
People
that
make those sorts of claims simply do not understand that the
doctor
repairing the colon will be a busy general surgeon who was not
involved
in
the case and now has to cancel his clinic or come in in the
middle
of
the
night for an urgent surgery. The GI doc who perforated gets
nothing
except
scrutiny.

This happened to our departmental secretary. She was a lady
who
weighted exactly the ideal weight for her height, and after the
surgery
to
repair the perforation, looked 5-6 months pregnant for about 1
year.
She
lost 6 weeks of work, and got billed about $35,000 for the
"repair."
Errors
are highly profitable to the system.

But not to the people who make them.


The system is what supports the current practices and no one is
going
to
criticize a physician who gives them a lot of profitable
referrals.

Correction: EVERYONE (hospital administration, coworkers, and the
surgeon
who comes out in the middle of the night) will criticize a physician
who
perforates colons a rate higher than what should realistically be
expected.



Everyone except the patient, who is never allowed to know who the bad
players are.

A patient in for a routine colonoscopy meets the doctor beforehand,
discusses the procedure, etc. If there is ever a perforation or some
other
problem, they know exactly who to come looking for.

But the patient never knows who is the player with a high number of
ruptures. That is carefully hidden from the patient. You wrote
"EVERYONE
(hospital administration, coworkers, and the surgeon who comes out in
the
middle of the night)" knows...but never the patient. Greshams law
applies
here.



And does anyone really keep track of the physician who
perforates colons at the higher rate than expected?

I'll be perfectly honest - yes and no. Since there is not one
"correct"
perforation rate and since such events are rare, it would hard to
measure
accurately.

You are engaging in mystification here. No one can know? You just
got
done saying EVERYONE knows....know you say no one knows.


That's the "no" part. The "yes" part is if there is an obvious
trend ... example 3 of the last 10 ended up colostomies - that would
noticed
by the department head, hospital administrator, and the general surgery
department.

Is that data every
systematically collected? Who would ever know? It is kept secret to
protect the system.

Who do you think should have access to such information?

PATIENTS

So patients should be given information about other patients? Hmm... that
might violate a few laws and ethical codes.


Ok, I get it. If we find out a doctor harms patients, then that must be

Ok, I get it. If we find out a doctor harms patients, then that must be
hidden to protect privacy. You just got done saying EVERYONE knew. Now
you
say it is unethical to let patients know about bad doctors. Figures.

BUT... should we all have this data readily available? If you're looking a
surgery you do 6 times a year, and you live in a small town...
confidentiality becomes a real issue.
I don't see how. You say I had six surgeries last year and of that

an oncologic surgeon who ends up doing most the really aggressive prostate
cancer surgeries, you'll end up with higher + margins, more complications,
and in general, outcomes that will look worse on paper. Conversely, if
surgeons in community are to be judged on this sort of thing, you know what?
Yet, don't many of these have well-established severity surveys that

These are all things I discuss with my patients.  I don't  hide any of them.
BUT... should we all have this data readily available?  If you're looking a
surgery you do 6 times a year, and you live in a small town...
confidentiality becomes a real issue.  If you are a tertiary care center and
an oncologic surgeon who ends up doing most the really aggressive prostate
cancer surgeries, you'll end up with higher + margins, more complications,
and in general, outcomes that will look worse on paper.  Conversely, if
surgeons in community are to be judged on this sort of thing, you know what?
You'll see them cherry pick their surgeries.  Why operate on a big fat guy
that has potentially for more complications?  Why operate on an aggressive
cancer since you run a risk of lowering your average of having + margins?
Send him off to the nearest "University Hospital" for that surgery (with all
the associated time delays risking metastatic cancer).