Mar ‘11
29
Troubling Trial of Surgeries
My UST colleague Tom Ressler is walking with difficulty these days. He’s had two lower back surgeries and faces the prospect of a third. I assumed he reads the Wall Street Journal here at Opus College so I didn’t send him the John Carreyrou and Tom McGinty story 3/29 on what the Medicare data base reveals of the propensity in this country, and among some surgeons, to perform multiple surgeries on the same spine. The Journal is doing a series entitled “The Secrets of the System” which translates what medical research tells us into a revealing portrait of American medicine. I can no longer shock audiences by telling them that American hospitals kill upwards of 100,000 of us unintentionally every year. Despite the fact Dr. Lucian Leape at Harvard and President Clinton drew our attention to the problem of medical errors 15 years ago, the IOM publicly gave dimension to the problem of 100,000 deaths ten years ago, and a pediatrician named Dr. Donald Berwick has made a crusade out of convincing doctors they must change.
Today Republican Senators have decided Berwick is not capable of heading the one agency in our government that has the data on how harmful the American health system is to Americans. And the membership to make it change. Medicare which he administers at CMS. The Journal story features neurosurgeon Vishal James Makker of Portland OR who attributes his propensity to do repeat surgeries (39 repeats for every 100 initial spinal fusions) on the many referrals he gets from other surgeons in the community. He has the nerve to say “I am the dumping ground for Medicare patients.” One of the questions you’ll ask as you read the story, is how unique is this guy? Another is why is it up to patients to have to blow the whistle on guys like this?
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What if the cost of the referral affects the referring provider? It might be more reasonable for the provider to have an incentive to not make a referral unless it is needed. My original idea was that HMO’s have an incentive to keep people well by prevention and that a oversight was only needed when there was a claim that referrals was medically needed. Tony