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Massachusetts health care — wonky, with a healthy dose of reality

The Heavy Price of Poor Quality -- Today's Washington Post

The Heavy Price of Poor Quality -- Today's Washington Post

July 24, 2005

Today's (Sunday's) Washington Post has the first of a three part series on poor quality in the Medicare program and the costs associated with it. (Click here -- free registration required.) Bottom line:

"In a four-year period, 106 heart patients at Palm Beach Gardens (hospital) developed infections after surgery, according to lawsuits and government records. More than two dozen were readmitted with fevers, pneumonia and serious blood infections. The lawsuits included 16 patients who died. How did Medicare, the federal health insurance program for the elderly, respond? It paid Palm Beach Gardens more. Under Medicare's rules, each time a patient comes back for another treatment, a hospital qualifies for an additional payment. In effect, Palm Beach Gardens was paid a bonus for its mistakes. Medicare's handling of Palm Beach Gardens is an extreme example of a pervasive problem that costs the federal insurance program billions of dollars a year while rewarding doctors, hospitals and health plans for bad medicine. In Medicare's upside-down reimbursement system, hospitals and doctors who order unnecessary tests, provide poor care or even injure patients often receive higher payments than those who provide efficient, high-quality medicine."

But, wait a minute, this is Massachusetts, the mecca of medicine. Aren't we great? Well, not really. The Post includes an informative interactive graphic showing each state's quality of care ranking along with its per capita Medicare spending. How does Massachusetts compare -- on quality of care, we're the 15th best; on costs were the 7th most expensive. Whose more expensive? Louisiana $8239, Texas (hi George!) $7558, California (hi Arnold!) $7289, Maryland $7190, Florida (hi Jeb!) $7111, New York $7035, MA $7012.

Whose better than us on quality? Fasten your seat belt:

  1. New Hampshire
  2. Vermont
  3. Maine
  4. North Dakota
  5. Utah
  6. Iowa
  7. Colorado
  8. Wisconsin
  9. Connecticut
  10. Minnesota
  11. Oregon
  12. Nebraska
  13. Montana
  14. Delaware
  15. Massachusetts

What kind of nonsense is the Post measuring? "Based on 24 basic measures of care from the Centers for Medicare and Medicaid Office of Clinical Standards for Quality, including the percentage of hospitals that give heart attack patients aspirin and Beta Blockers within 24 hours of admission."

Fascinating isn't it? Not one of the top 6 most expensive states makes the list for the best on quality. And the prize goes to ... Louisana. Hold the gumbo ... # 50, dead last on quality, and #1 on cost. That takes work doesn't it?

The health care cognoscenti want us to believe the problem with health care is the insatiable demand by consumers for services. Health system, heal thyself!