Wrong-incentive health care

Health care pontificators like to talk about incentives.  Who can blame them/us?  Health care pays its players (or, all too often, doesn’t pay them) to do some funny things.

Today’s example is from The New York Times.  Background info, “One in five Medicare patients, for example, returns to the hospital within 30 days. Over all, readmissions cost the federal government an estimated $17 billion a year.”  Wrong-incentive health care:

Medical providers all too familiar with the financial double bind include Park Nicollet Health Services, a hospital and clinic system based in St. Louis Park, Minn. Park Nicollet started tackling the readmission problem four years ago, spending as much as $750,000 annually on more nurses and on sophisticated software to track heart failure patients after they left the hospital. It reduced readmissions for such patients to only 1 in 25, down from nearly 1 in 6.

But the reduction has been a losing proposition. Although the effort saved Medicare roughly $5 million a year, Park Nicollet is not paid to provide the follow-up care. Meanwhile, fewer returning hospital patients mean lower revenue for Park Nicollet.

Technology assistance

BusinessWeek‘s Gene Marks feels sorry for doctors because of the way they are being forced to purchase technology.  The issues facing independent physicians:

For example, right now there are dozens and dozens of companies offering technologies that claim to provide electronic health records. And guess what? None of their systems talk to each other. Surprise! And none of them have the same architecture. And they don’t exchange data with all the same hospitals. That’s because most hospitals’ systems are all over the place too. What, you think those big hospitals actually have their act together?

Has such a high tech industry ever had so much trouble implementing personal technology?  Feel bad for physicians, yes.  That financial benefits of an EMR accrue to payers, hospitals, and to the larger system is but one reason.  But sooner or later, a minimum level of technology in the exam room is the price of entry, right?  So the U.S. federal government is on board with the stimulus bill—should assistance to physicians in purchasing technology end there?  Does the mandate preclude participation by commercial payers and hospitals?