Health Care Thoughts: Regulations Gone Wild
As Rusty presents his short ‘thoughts’ on the administrative end of the national healthcare reform process, I noticed some readers have taken the problems he notes as indicative that the whole process is flawed and destructive. I do believe that is a wrong tack to take and will not serve to learn more of what is happening in the process. The US public has only begun to take note of the growing necessity of deciding not only public spending but the huge costs to the current private system. Changes are happening in that area as well.
The steadily increasing complexity of insurance billing and particular contracts with groups is simply bypassed in macro discussions but has profound effects on delivery of services and costs. We glibly point to general ‘benefits’ sections of insurance as the ‘worth’ of plans and that justify the ‘premium’ schedules….not the real contracts on the other side of service delivery. Many general public discussions ignore the trends in the private sector. The overall costs of the system itself as the ‘cost curve’ bends downward without much general scrutiny will impact more than the handy medicaid and elderly targets in the political discourse..
Health Care Thoughts: Regulations Gone Wild
My favorite nurse has been attending in-services and doing some computer seminars on long-term care nursing. She is not happy.
She sat down the other evening and put together a list of 15 major regulatory driven changes in procedures and/or documentation. In reviewing the list, she determined that 2 or maybe 3 of the changes will improve the quality of care or the safety of residents.
So what about the rest?
She doubts that changing a 16 step process for administering sterile eye drops to an 18 step process will have much value. If she uses the 16 step process in the presence of a state or federal surveyor the facility would be cited for inadequate care, even though the care is perfect.
And the triplicate procedures for verifying narcotics are ever expanding into four and five step processes repeated multiple times each day (the DEA, having won the war on drugs, has been hounding nursing homes on paperwork).
Keep in mind a nursing home has much more extensive documentation rules that even an acute care hospital, with less staff.
When business and professional people complain about federal regulations, many academics and left leaning politicians pooh-pooh them as greedy whiners, but in the real world there are real impacts of regulations, not all positive.
Tom aka Rusty Rustbelt
this is bull shit
rdan,
I am not sure what is going on in this post.
Your editorial at the beginning asserts some things about private insurance billing, while Rustys’ post *seems* to deal with government regulations. I don’t know if this was intended but it doesn’t make for a very good post.
This gives the appearance of being a point/counter point post. Was that the intention?
very valuable response – duh
I got a little lost too – I think he was saying the actual day-to-day work gets lost in the discussion of macro issues (?) which is where I was headed also.
Actually the concept of the process, is tied to work by Gwande suggesting checklists. It turns out that after the first DC-3 crashed the flight industry invented the checklist because there was to much to remember without such a list. Gwande recommends this for health care also, all be it that 18 steps are a bit much by his liking. One question occurs here which committe invented the process, and what comments were made to the rules. Of the steps how many involve the simple act of being sure that the right medicine is associated with the right patient, I have read there are often errors in this step. Now a bit of IT such as putting a patient bar code on all medicines for that patient, and scaning the wrist tab and the bottle, could help here.
For anyone wanting more information:
http://www.cms.gov/manuals/downloads/som107c07.pdf
http://www.cms.gov/manuals/Downloads/som107ap_p_ltcf.pdf
www.fmdrl.org/index.cfm?event=c.getAttachment&riid=3048
Note: the PDF files are long and have hundreds of links to statutes and regulations – the powerpoint I just found browsing and it is an excellent plain English summary.
The checklist and reduncy concepts have been around in nursing a long time.
The problem is bureaucrats deciding their checklist is superior to proven methods, when the bureaucrats do not have to deliver the care and are not on the floor when multiple crises are occuring with residents.
Can some elaborate what is the national healthcare reform process is all about?
Nose Reshaping in Thailand
This is out of control, PPACA is going to put so much pressure on the states in a time when the budget deficits have never been worse. To make it even worse state stimulus (FMAP) rolled off this year.
This site has covered it some:
http://Www.streetofwalls.com