"prospective payment is a system (Medicare uses it, and where Medicare goes, other insurance systems quickly follow) in which a hospital is paid X number of dollars to treat Y diagnosis. If they get it done quickly and cheaply, they show a profit. If there are complications, and most of the time these days people have multiple co-morbidities, then they can lose lots of money in a hurry."
Suppose I am in the profile of patient who will easily contract pneumonia and ARDS if admitted to hospital for major surgery. For one reason or another an ultrasound is run on me and I am diagnosed with a circulatory disorder.(Supposedly one of my arteries has ballooned out and the suggestion is it may easily burst).
My doctor recommends surgery saying I would normally be considered too old, but I am very strong.
My prognosis of the hospital system is that it's very unhealthy for me.
There will quite likely be complications. According to the quote above, it looks like the hospital will panic. No-one seems to be factoring in, the risk of iatrogenic complications.
The pneumonia and ARDS are essentially iatrogenic.
Am puzzled because this unhealthy hospital system would need some way of rapidly shutting me down if I develop complications.
So I was encouraged to have the operation but I wasn't told that the hospital system has a way of rapidly shutting me down if I develop complications.
Given the decision to operate, I don't see why pneumonia and ARDS are considered as complications. Treatment for these should be part of the service.
There seems to be some Machiavellian plotting going on behind the scenes.
One group is arguing that treatment for predictable complications pneumonia and ARDS should be part of the service, and another group is arguing against this.
Worst case scenario is I'll be euthansed as some sort of test case, to set a precedent for future standards of service. It may seem the the PPS system may motivate health care providers to "cut corners" by not performing certain tests and procedures. The less the hospital actually does to you, the more money they get to keep.
Yet, we must remember that we are still held to the same standards of care and protocols that were in place prior to the PPS system. In the case you mention above, the doctor is considering surgery because you are an otherwise healthy person and are being considered for this surgery because of the vascular anomaly that was found. The irresponsible system would say "well, he doesn't meet the criteria for age, so we are under no obligation to perform the surgery."
Rather than viewing PPS as an "unhealthy" system, I view it as a much needed reality check to prevent uneccesary procedures. Prolonged use of the fee-for-service system is what got us in the mess that we are in now (escalated cost of health care). The PPS system made health care professionals take look at what they were doing and hold them accountable for the procedures they performed. Out of it comes much research investigating the validity of the treatments and tests that were being performed. Prior to this, many things were performed haphazardly.
I view the PPS system as a way of making the provider more responsible for what they are doing. What benefits the patient is that charges above and beyond the PPS are not directed toward the patient. Again, it is the hospital's responsibility for charges above and beyond. |
