Hospitals Gaming the System to Show Good Metrics

On Behalf of | May 3, 2012 | Uncategorized

Concerns about the quality of care in hospitals are common among Chicago residents. For instance, it is often difficult to teach doctors to follow basic procedures when treating patients, such as using checklists or washing their hands. Failure to follow such procedures can be a form of medical malpractice.

It is not surprising that there are also issues with measuring the quality of treatment. New research shows techniques that hospitals are using to game the system and make their medical outcome statistics look better than they actually are.

For example, a report from the Journal of the American Medical Association stated that pneumonia rates dropped 27 percent over a six-year period. Researchers dug further, however, and published a new report showing that the rates dropped only because hospitals changed their diagnostic coding system to classify pneumonia as a secondary diagnosis.

One possible reason for this change is that diagnostic codes enable hospitals to bill patients at higher rates. Critics argue that this presents a conflict of interest, because medical professionals who study and propose changes to billing and coding systems stand to personally gain from changes.

Hospitals, like any other for-profit business, are managed with the principle goal of maximizing profit. Maximizing compensation through billing practices presents a shortcut to achieving this goal.

In addition to changing diagnostic codes, other dubious hospital practices include transferring dying patients to other facilities to keep their mortality rates low.

Some argue that the problem lies with measurement. For instance, hospitals are penalized based on readmission rates, but only a small percentage of those are truly preventable. Many hospitals focus on these areas that are largely out of their control, rather than care issues in greater need of improvement.

When the quality of any organization is measured, the organization naturally seeks a way to improve its numbers. Patients considering health care data before making hospital choices should be aware of questionable practices by some hospitals.

Source: “Why the fragility of health outcomes research may be a good outcome for health,” David Shaywitz, Forbes, 4-5-12


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