I’m sure the architects of ObamaCare had good intentions. They never would have considered that this new healthcare legislation might actually lead to an increase in deaths. In fact, I’m sure they assumed the opposite.
But well-intentioned legislation often has unintended consequences.
New Study Results
The Wall Street Journal reports the findings of a new study in the Journal of the American Medical Association Cardiology suggests regulations in ObamaCare could be responsible for an increase in deaths.
A little known provision of ObamaCare included monetary incentives and penalties designed to induce changes in healthcare delivery and lower costs. These experimental payment models were rolled out nationally without careful study and the result is unintended side effects.
One example is the Hospital Readmissions Reduction Program, which penalizes hospitals with above-average readmissions for Medicare patients. Since readmissions drive up spending, the goal of the penalties is to encourage providers (hospitals and doctors) to take measures that reduce repeat hospitalizations. Examples would be providing patients with clearer discharge instructions and coordinating with primary-care physicians.
Hospitals are compared with national averages and cited if their 30-day readmission rate exceeds the average. Therefore, hospitals can actually be penalized even if they reduce readmissions. The penalties are assessed by reducing Medicare payments. A wide variety of medical conditions are monitored including knee and hip replacements.
Proponents of ObamaCare have touted data showing that readmissions have fallen since the penalties took effect in 2013. That’s not surprising if hospitals lose money. But the real question is what impact this has had on the patients.
The JAMA researchers examined the impact on quality of care. Their study of 115,245 Medicare patients hospitalized with heart failure looked at patients in the four years prior to and the first two years following implementation of the program. They found that the 30-day readmission rate decline to 18.4% from 20% after introduction of the penalties. But the 30-day mortality rate increased from 7.2% to 8.6% – which means about 5,400 additional deaths per year!
In other words, fewer patients were being readmitted but many more were dying.
The researchers speculated on the reasons for this increased mortality and hypothesized hospitals may be trying to “game the system.” Possible strategies included:
- Hospitals delaying readmissions beyond 30 days to avoid penalties
- Increasing observation stays to lower in-patient admissions
- Shifting in-patient care to emergency departments
- Hospitals with above-average readmissions are more likely to care for low-income patients with complicated medical cases – higher risk patients
The JAMA researchers concluded that, “like drugs and devices, public health policies should be tested in a rigorous fashion – most preferably in randomized trials – before their widespread adoption.”
The Wall Street Journal editorial board says, “Sounds like good advice, but not the sort that ObamaCare architects and masters of the economic-planning universe like Peter Orszag and Jonathan Gruber are inclined to take.”
As surgeons we are always looking for ways to do surgery through smaller incisions that will allow faster recovery. But we must always measure these new procedures against the high quality gold standard of the conventional procedure. Speed of recovery is never an improvement if the quality of outcomes is sacrificed.
The lesson here is clear. New government programs in healthcare must not only meet economic goals but must also maintain the same high quality medical standards established by the present system. Lower costs are never worth the price of more deaths.