California Society of Anesthesiologists Bulletin Spring/Summer 2014 - (Page 7)
PEERING OVER THE ETHER SCREEN
The Dark Side of Quality
By Karen S. Sibert, MD, Associate Editor
N
obody stands up to argue against quality and value in health care. You might as
well argue against motherhood, or puppies. Yet many physicians are inherently
skeptical of definitions of "quality" that are imposed from above, whether by outside
evaluators like The Joint Commission or (worse) by the government.
There's good reason for skepticism. Some of the "evidence" behind "evidence-based
medicine" has turned out to be flawed, tainted by financial conflict of interest or
outright fraudulent. Any experienced physician knows that there are fads in health
care just as there are in fashion, and today's evidence-based medicine may be
tomorrow's malpractice. Let's take a closer look at what's really going on in the world
Editor's Note: In 1974, Robert Pirsig published
his philosophical tour de force Zen and the Art of
Motorcycle Maintenance. Subtitled "An Inquiry into
Values," the book detailed Pirsig's pursuit of the
meaning of Quality, metaphorically unraveling his
search through a motorcycle journey undertaken
with his son from their home in Minnesota to the
San Francisco Bay Area.
In this issue of the CSA Bulletin, Associate Editors
Karen Sibert, MD, and Kenneth Pauker, MD, have
undertaken their own inquiries into the meaning of
Quality, specifically in the practice of medicine. Dr.
Sibert begins with a skeptical take on several of the
currently mandated quality initiatives; Dr. Pauker
then uses Dr. Sibert's article as a springboard for a
detailed analysis of our attempts to define, measure
and improve quality in the delivery of health care.
Finally, Dr. Lee Fleisher, Robert D. Dripps Professor
of Anesthesia at the University of Pennsylvania,
comments on Dr. Sibert's discussion of the issue of
perioperative beta blockade.
Although Zen and the Art of Motorcycle Maintenance
was often entertaining and, misleadingly, easy to
read, at times it could be dense and intellectually
challenging. Our authors' investigations are no
different, but, like Pirsig's, well worth the effort.
of quality metrics, and why it matters if payments to
you and your hospital are increasingly linked to how
you score.
Surgical Site Infections
The financial toll of surgical site infections (SSIs) is
huge, estimated in the U.S. at more than $10 billion a
year.1 A recent retrospective review from the Veterans
Affairs Surgical Quality Improvement Program showed
that the majority of SSIs are diagnosed only after
hospital discharge, and that 57 percent will require
hospital readmission within 30 days. 2 The Centers
for Medicare and Medicaid Services (CMS) stopped
paying for care related to SSIs in 2008 by designating
them as "never events," or non-reimbursable serious
hospital-acquired conditions. Now, SSIs are part of
a long list of hospital-acquired conditions that can
result in reduced CMS payments to hospitals, and
will bring further reduction in payments over the next
several years with the implementation of "value-based
purchasing." More than 1,400 hospitals will see their
Medicare payments cut by as much as 1.25 percent this
year - a margin that could spell financial disaster for
hospitals already struggling. 3
(continued)
Spring/Summer 2014 | 7
Table of Contents for the Digital Edition of California Society of Anesthesiologists Bulletin Spring/Summer 2014
Editor's Notes
President's Page
Peering Over the Ether Screen
The Dark Side of Quality Reilluminated and Reimagined
The Perioperative Use of Beta Blockers
ASA Director's Report
Physician Well-Being
Upcoming CSA Anesthesia Seminars
Our Stories
From the Executive Director
Our Stories
Practice Alert
On Your Behalf: Legislative and Practice Affairs
CSA Political Alert
Taking the CSA Grassroots and GASPAC Program from 'Good' to 'Great'
CSA Winter Anesthesia Seminar 2014: Midwinter Educational Interlude
California and National News
News from the Districts
California Society of Anesthesiologists Bulletin Spring/Summer 2014
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