Dorothy Guellec
The
American Medical Association believes it may have discovered a root cause for
the many medical errors – patients themselves. Isn’t that cute. Rather than
focus on the incredible complexity of the system and processes at work and
everything needed to reduce errors, let’s pick on someone to blame. This is not
a coincidence, not by a long shot. The Institute of Medicine is preparing to
release a second report on healthcare quality (early February 2001) at a time
when many providers and lawmakers are still trying to digest the impact of the
institute’s 1999 medical errors study "To Err is Human." To prepare
the way the AMA Foundation, the philanthropic arm of the AMA, said late last
week (Jan. 2001) that " the problem of patients not being able to
understand, interpret or act on basic health information results in $73 billion
in unnecessary health expenses nationwide." It is developing a program to
address the phenomenon.
This
sizeable expenditure, the AMAF (American Medical Association Foundation) notes,
is the result of something called "low health literacy." This means
that patients cannot understand, interpret, or act on basic health information,
such as instructions on prescriptions. Rather than fulfill the basic
doctor-patient covenant within the implied, if not explicit, community of trust,
the Foundation representing the American Medical Association blames the patient.
This analysis ignores all the realities of the market driven share-holding
system. It is downright nasty to attribute the 44,000 to 98,000 mistakes in all
parts of the giant healthcare industry to "low health literacy "
whatever that means. This is grasping for straws. Low health literacy is not the
answer, and life is not that simple, and the patient for one is never at fault.
The AMA goes on to define low health literacy as "the inability to act on
basic health information such as appointment slips, informed consent documents,
insurance forms, or other health educational materials. With more than 90
million Americans or 46% of the adult population today considered functionally
illiterate, low health literacy is becoming a dangerous and alarming public
health issue" Maybe they think that a naïve, incorrect and damaging
analysis such as this will cover their tracks, and more importantly, serve as a
buffer when the second Institute of Medicine’s Report is released in February,
if it isn’t stopped by certain parties. The impending release is already
generating a buzz in healthcare circles.
Lucian
Leape, M.D. an adjunct professor at the Harvard University School of Public
Health who worked on both Institute of Medicine’s reports, promises that the new
report will be "equally radical" to its predecessor. Kenneth Kizer,
M.D., president and chief executive officer of the National Quality Forum, has
read the report and said it makes "some very poignant
recommendations." I am sure that patient error, or blaming the patient,
does not figure except very briefly, in this new report. Dr. Kizer’s forum is a
Washington-based-not-for-profit membership organization whose goal is to improve
quality measurement and reporting in healthcare. It’s working on three
patient-safety projects for HHS.
"Basically,
it’s about the need that healthcare has to focus on quality, which has to be an
essential business strategy for the healthcare industry," Kizer said. As
healthcare inflation continues to rise, no easy places to cut costs are left, he
said. "You have to improve the processes of care." Note how quality
has to be a business decision and not a humanitarian one. Then, if all else
fails, the entire industry can blame the patient and his or her lack of health
literacy skills.
The
AMA’s call to action comes only days after an article in the mainstream
revealed, and HCFA confirmed, a change in federal policy that will require
Medicare peer review organizations to tell patients whether their hospital and
physician care met "professionally recognized standards." Tens of
thousands of Medicare patients file complaints each year about the quality of
care they receive from doctors and hospitals. But in many cases, patients get no
useful information because doctors can block the release of assessments of their
performance. No more. Under a new policy, officials said, doctors will no longer
be able to veto disclosure of the findings of investigations.
The
new policy came in response to a lawsuit against the government by the son of a
Medicare patient who was admitted to a hospital in Jacksonville, Fla., on Dec 8,
1998, after an asthma attack and after experiencing high blood pressure. The
patient died from a stroke six days later, while still a patient at the
hospital. The plaintiff (the patient’s son) had concerns about his mother’s
care. He filed a complaint, which was investigated by a group of medical quality
experts known as a peer review organization. Mr.Levine (plaintiff) and his
lawyer, Amanda Frost of the Public Citizen Litigation Group, a nonprofit law
firm, filed a lawsuit, in which they argued that the old Medicare policy
violated federal law. The suit is pending in Federal District Court in D.C.
The
AMA finger pointing at patients comes right after the Joint Commission on
Accreditation of Healthcare Organizations adopted new accreditation standards
that will require physicians to tell hospital patients when their clinical
outcomes deviated from acceptable norms. The sweeping requirements for
accredited hospitals include six new standards, such as mandating that hospitals
implement organization wide safety programs and revise 29 existing standards.
Just
to make us all feel secure across the nation, 933,687 elderly and disabled have
been dropped as of Jan 1st by HMO’s pulling out of the Medicare program
according to the US government. These Medicare recipients – a sixth of those
enrolled in HMO’s – are "likely to be poorer, less educated and in worse
health than others in the program." Terminations in 2000 affected a
disproportionately vulnerable subgroup of beneficiaries, many of whom were
confused about options and worried about the future. I can’t wait to see what
2001 brings.
"I
think it’s a dirty trick," Mr. Castle, 73, said as he thumbed nervously
through the thick stack of papers he had brought to the Elderly United Downtown
Center in Springfield, Ohio in search of advice from Lynn Heskett, the center’s
medical claims coordinator. As they spoke, Ms. Heskett’s phone rang incessantly
with calls from other elderly people in the same predicament.
Although
everyone dropped from a Medicare HMO can return to the basic fee-for-service
Medicare, it does not pay for drugs. Neither do the supplemental Medicare
policies, the so-called Medigap plans, in which enrollment is guaranteed to
those who are dropped. The costs of these policies, which pay doctor and
hospital charges not paid by Medicare, vary among the private companies, and
state to state. In Ohio, they cost from $40 to $143 a month. The few that cover
drugs cost as much as $418 a month and acceptance is not guaranteed.
The
HMO industry shakeout started 3 years ago and continues due to mergers,
acquisitions and outright failures. I personally think the system will
eventually self-destruct, but so-called experts in the healthcare industry do
not agree. We can expect that the number of HMO players – now about 568 – and
the number of enrollees will continue to drop and the sector will reshape
itself. Meanwhile the nation’s largest hospital company (for profit of course)
which awed Wall St. for more than a decade agreed to $95 million in criminal
penalties and pleaded guilty to charges that "it obtained some of its money
by cheating government health care programs." The settlement with HCA, the
Healthcare Company amounts to the largest fraud settlement in American history.
HCA has agreed to pay a total of $840 million in criminal and civil penalties.
Dorothy
Guellec
