WHAT A DISGRACE!

How surpising (not) that VA hospitals should be singled out for adverse mention!

If you became seriously ill, you'd expect a hospital to provide what the medical profession considers essential care. At many hospitals, you'd be wrong. Thousands of patients needlessly die each year because guidelines proven to save lives aren't followed.

Even the most basic lifesaving treatments, such as giving aspirin and other drugs known to help heart attack victims, are forgotten, with fatal results. A study last November of 315 hospitals by the Duke Clinical Research Institute found failure to follow widely accepted heart attack guidelines almost doubled the mortality rate. After seeing the data, hospitals that improved their compliance rates had 40% fewer deaths.

Now, a national system to grade how hospitals meet standards is slowly emerging, using Medicare as the primary leverage, but enticing private insurers as well. It has a lot in common with the carrot-and-stick method used to get a mule to do what you want.

Over time, hospitals will get more money if they follow guidelines, and lower fees if they neglect them. To add a further shove in the right direction, Medicare will post report cards on its Web site so the public can make comparisons.

Until recently, there has been little incentive to measure performance. Unlike most businesses, where those who offer better services or products receive the largest financial reward, health care institutions mainly get paid based on volume of services rather than whether patients get better. Under the perverse reimbursement scheme, avoidable complications that require readmission may actually be more lucrative to hospitals than getting it right the first time.

Collecting and sharing information is the first step to improved care. In 1996, only 30% of patients who needed pneumonia vaccines received them at Department of Veterans Affairs hospitals. Once physicians were made aware of that fact, the rate went up to 92%, saving an estimated 6,000 lives. The use of beta blockers, which slow the heart rate and are standard for heart attack patients, went from 70% to 98%.


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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation.

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