Should Health Care Come with a Warranty?

[REACTIVATED IN CT]

Interesting concept. This was done at a hospital in PA or NJ.


<snip>
Synopsis
Warranties are commonly used in various industries to protect consumers against faulty products, but they are rare in health care. This study finds that warranties could improve the care that patients receive while enabling medical providers to improve their profit margins.
<snip>

<snip>Using data from a large commercial insurance database, the authors modeled the impact of a new payment model that features a de facto warranty, in order to gauge the impact on providers' profit margins—specifically, for treatment of patients with acute myocardial infarction, or heart attack. Under the "Prometheus Payment" model, developed with support from The Commonwealth Fund and the Robert Wood Johnson Foundation, a risk-adjusted "evidence-informed case rate" (ECR) is used to reimburse providers for the care of a patient diagnosed with a specific condition. A global fee covers all services recommended by well-accepted clinical guidelines or expert opinions, including all inpatient and outpatient treatment delivered by physicians, hospitals, laboratories, and other providers. But while the ECRs fully compensate providers for the expected costs of providing evidenced-based care, they only compensate providers for half of the predicted cost of dealing with potentially avoidable complications—in effect, creating a warranty. Thus, providers “win or lose financially based on their actual performance in reducing the incidence of avoidable complications.” <snip>



<snip>
Addressing the Problem
Fee-for-service payments reward volume of services provided, not quality of care. In some cases, providers are even rewarded for poor care—through payments for the treatment of complications that could have been avoided. The authors say that health insurance coverage expansions will not be sustainable unless better and more cost-effective care is encouraged. The Prometheus Payment model offers one approach. <snip>


http://www.commonwealthfund.org/Content/Publications/In-the-Literature/2009/June/Should-Health-Care-Come-with-a-Warranty.aspx

[Warpy]

1. No, because

of one of the corollaries to Murphy's Law: nature always sides with the hidden flaw.

The standard of care for any illness which presents itself but which doesn't address the hidden flaw will ultimately fail.

Unless every single person who dies is autopsied to find the immediate cause of death, a crippling expense, the payouts on warranties will cripple the health care system more than it already is.

There are no guarantees with medicine. It is practiced only according to the evidence of what has worked for most people.

While people focus on the transfer of money between provider hands, our system will continue to be the most expensive, most spectacular failure in the world. Payment for service required because of complications is in no way a reward for bad care any more than it is a punishment for the insurance industry or the patient who had the hidden flaw.

When we focus on the delivery of care, we will start to see a bit more success, at least in human terms.

[REACTIVATED IN CT]

2. Its not technically a warranty in the sense that you

are interpreting it. It's a payment method - and regardless of who is paying, insurance company or single payor, there will be a method of compensation. This one sets a flat amount for a procedure that takes into consideration some costs for complications. The provider doesn't get to bill for every IV, every medication,, every test, etc. They are just paid the flat amount. If the provider's care avoids complications, they will make more profit which should serve as motivation to find ways to avoid complications.

I guess the downside to this method would be that providers could cut corners to cut costs.

[Fire_Medic_Dave]

3. Are routine complications avoidable?

I could actually see it increasing costs. If doctors begin pre-treating everyone for possible complications then costs could increase. Of course we may find that in fact pre-treating for these routine complications is the best way to deal with them regardless of costs.

David

[Warpy]

4. It ASSumes that complications are always avoidable

so please refer to what I said about Murphy's Law. Most patients have hidden disease processes and some of those disease processes will cause complications no matter how vigilant the provider is.

Again, anything that focuses entirely on COST will continue to be inefficient and inhumane.