Who knows what the Supreme Court will say about the ACA. Strange, isn't it, how something so far from politics as health care will break along predictable political lines in the court, with one swing vote, as usual, being decisive. Whatever they decide, our health care system will remain astoundingly dysfunctional.
When I was in training, we were told that pre-op antibiotics had to be given at least an hour before the operation started; the opposite, in other words, of now. The idea was that it took that long to establish effective tissue levels, as opposed to blood levels, of the drug. Whatever. I'm certainly in favor of testing old theories and establishing new procedures based on new data. But that's not my point. The point is that tracking the timing of antibiotic delivery is as easy as it is arbitrary. Fifty-nine minutes: good. Sixty one: fail.
If a hospital delivered care for less than the bundled rate, while hitting certain quality metrics, it would keep the difference as profit. But if costs were high and quality was too low, Baptist would lose money. For the first time in their careers, the doctors’ paychecks depended on the quality of the care they provided.
Four surgeons quit in protest.
“I’d describe the reception as lukewarm at best,” Zucker says. “There was a lot of: ‘How could you do this?’ and ‘I’m not going to participate.’ ”
The program launched in June 2009 with a checklist of quality metrics. To earn a bonus, surgeons would, among other things, need to ensure that antibiotics were administered an hour before surgery and halted 24 hours after, reducing the chances of costly complications.
Only three doctors hit the metrics that first month, but their bonuses caught the attention of others. “There was a lot of, ‘Why are those doctors getting more, and I’m not?” Zucker says. Eight doctors got bonus payments in July; two dozen got them in August. Compliance with certain quality metrics steadily climbed from 89 percent to 98 percent in three months.
Two-and-a-half years later, Baptists’ surgeons have earned more than $950,000 in bonuses. Medicare, meanwhile, has netted savings: Its bundled rate is about 5 percent lower than all the fees it used to pay out for the same services.