Not Good News

[xoxoxoBruce]

The News Medical website reports a study by Harvard Medical School found, the "Occurrence of postsurgical complications associated with higher hospital profit-margins".

Excuse me, if you fuck up you make more money? Not good news.

"The rate of inpatient surgical complications is significant, with estimates ranging from 3 percent to 17.4 percent, depending on type of procedure, type of complications, length of follow-up, and data analyzed. In addition to patient harm, major complications add substantial costs, previously estimated at $11,500 per patient.

Effective methods for reducing surgical complications have been identified. However, hospitals have been slow to implement them," according to background information in the article. The authors write that there may be several factors for slow implementation.

Reductions in surgical complication rates "can reduce revenues under per diem reimbursement schemes and even diagnosis related group-based reimbursement because complications can result in severity adjustments or diagnosis related group changes that increase revenues. … Previous estimates suggest that reducing surgical complications could harm hospital financial results but have been limited by use of small data sets or simplified surrogates such as patient length of stay."

Good lord, we know from a number of recent articles the MBAs have taken over the hospitals. With this information, although they probably already knew it, they'll be ordering staff to stop washing their hands.

[footfootfoot]

I think the only thing worse than being in the medical system in this country is being in the criminal justice system. Pray for good luck.

[DanaC]

You know, if you say MBA three times whilst staring at the computer screen, tw appears in the thread.

[ZenGum]

FFF, that is a disturbing observation.

[orthodoc]

Post-surgical complications aren't always a matter of surgeons fucking up. Sometimes - but not always. For example, if you're a 380 lb 5'5" sedentary Type 2 diabetic smoker who needs a cholecystectomy (gallbladder out), what do you think your chances are of post-op complications? Pretty damned high. You'll need an open procedure rather than a lap, for a start, because you have too much fat for the surgeon to see anything using a laparoscope. Not the surgeon's fault that you're now having a higher-risk procedure with more tissue trauma, infection potential, and longer recovery time. Then, you've given yourself a double-whammy with your diabetes and your smoking in that you won't heal well. You'll be at high risk of pulmonary complications, blood clots with pulmonary emboli, and dehiscence - the wound simply doesn't heal together and falls apart within a few days as the weight of your fat-laden tissue pulls against it. You'll be at much higher risk of infection - your diabetes and your smoking both suppress your immune system. You'll be harder to mobilize, more likely to need extensive pain meds that make you dopy and harder to get moving, and again your risk of blood clots shoots way up. Your gut will take longer to start moving again.

None of these things are related to surgical technique, nor even to post-op care. They are all squarely the responsibility of the patient in coming to surgery with huge lifestyle-related health issues that have made it almost impossible to have surgery without complications.

CMS is taking care of that, however. Are people being strongly encouraged to eat and live healthier? Haha, you jest. No, the CMS solution is that surgeons and hospitals won't get paid for the surgery if complications occur. They are the ones who'll be punished if people don't get off their butts, exercise, eat right, stop smoking, and get healthy prior to having surgical procedures.

[xoxoxoBruce]

Ortho, calm down. Now breathe.

Effective methods for reducing surgical complications have been identified. However, hospitals have been slow to implement them.

They're talking about business decisions, infection prevention being a good place to start.

[orthodoc]

Ah, sorry, Bruce. It's been a bad weekend.

[xoxoxoBruce]

No need to apologize to me. Just don't want to add to your stress.

[ZenGum]

I can think of three possible solutions, but I don't think any of them work.

1. Publish each hospital's success rate / complication rate / adverse outcome (death) rate on a comparative website, so people can choose to avoid the worse hospitals.

2. Hospitals don't get paid for operations where complications develop.

3. Hospitals get a flat rate for each type of operation (i.e. $5,000 for an appendectomy) regardless of complications, the average cost of which would then be spread over all operations of that type.

The big problem with all three of these is that they give hospitals a motivation to refuse to do operations on higher risk patients. This would be bad.

So, we could oblige the hospitals to do the operation, regardless of higher risk factors. Again, bad, sometimes a doctor should rightly refuse to do a surgery.

Clearly, the solution is to mumble mumble mumble as soon as practical.

[footfootfoot]

Originally Posted by orthodoc

Post-surgical complications aren't always a matter of surgeons fucking up. Sometimes - but not always. For example, if you're a 380 lb 5'5" sedentary Type 2 diabetic smoker who needs a cholecystectomy (gallbladder out), what do you think your chances are of post-op complications? Pretty damned high. You'll need an open procedure rather than a lap, for a start, because you have too much fat for the surgeon to see anything using a laparoscope. Not the surgeon's fault that you're now having a higher-risk procedure with more tissue trauma, infection potential, and longer recovery time. Then, you've given yourself a double-whammy with your diabetes and your smoking in that you won't heal well. You'll be at high risk of pulmonary complications, blood clots with pulmonary emboli, and dehiscence - the wound simply doesn't heal together and falls apart within a few days as the weight of your fat-laden tissue pulls against it. You'll be at much higher risk of infection - your diabetes and your smoking both suppress your immune system. You'll be harder to mobilize, more likely to need extensive pain meds that make you dopy and harder to get moving, and again your risk of blood clots shoots way up. Your gut will take longer to start moving again.

None of these things are related to surgical technique, nor even to post-op care. They are all squarely the responsibility of the patient in coming to surgery with huge lifestyle-related health issues that have made it almost impossible to have surgery without complications.

CMS is taking care of that, however. Are people being strongly encouraged to eat and live healthier? Haha, you jest. No, the CMS solution is that surgeons and hospitals won't get paid for the surgery if complications occur. They are the ones who'll be punished if people don't get off their butts, exercise, eat right, stop smoking, and get healthy prior to having surgical procedures.

Pollyanna