Monday, January 02, 2012

PQRI...a Bad Joke?

The latest bureaucratic muddle emanating from Czar-Land, otherwise known as the Obama administration, is something called the Physician Quality Reporting Initiative, which ties the payment for medical treatment of old codgers, presumably anyone 65 and up and therefore on Medicare/Medicaid, to a report-card indicating physician-capability. Governmental bureaucrats with non-physician backgrounds will complete the reports that will separate the good doctors from the bad ones and determine the amount of reimbursement…or none…for each. It seems unclear as to what this amounts to vis-à-vis the doctors especially with respect to punishment or certification but, as Speaker Pelosi would counsel, this will be known only after the program is in place.

This could do for the elderly patients what No Child Left Behind has done for education – kill the process. NCLB has developed a national cadre of the mentally-challenged…a hopeless failure. The PQRI, hopefully, will not kill medicine, but don’t bet the farm. If it does, the old codgers may suffer and/or die but…hey…life is not forever.

PQRI will require a bureaucracy of immense proportions since there are some 800,000 practicing physicians in this country. Since it’s unlikely that the physicians will be required to take a written test (imagine the number of non-physician folks required to grade especially the essay questions), the appropriate bureaucrat will probably have to comb through records, follow-up on patient complaints, check the legal archives for lawsuits, practically live in hospitals and physician-offices and try to evaluate such hugely important things as bedside manner or the proper care of a hangnail.

One can imagine the bureaucratic red-tape connected to having a body exhumed in order to discover if a physician took out the wrong lung or left a wayward sponge among the pancreas, the better to determine if the surgeon was perhaps drinking on the job, a certain no-no in PQRI, and must therefore be given an “F” on his report card and, worse, paid nothing. One can just imagine the increased activity in law schools, which always benefit enormously when the Congress/administration comes up with new legislation/regulations concerning anything. Top Czar Sunstein, the chief among regulators, has already stated that animals should have access to lawyers, so one can only imagine how many lawyers will be needed by both bureaucracy and doctors to save the country from malpractice.

What would be the subjects of testing – operating-room procedure; time spent with patient; bedside manner; office manner; sterilization techniques; legible writing of prescriptions (although PQRI demands everything but probing for the appendix to be done electronically, including records and prescriptions); treatment of colleagues, including harassment of nurses by either doctor-sex; harassment of patients; proper suturing/stapling/bone-sawing; full disclosure of successes/failures regarding surgical procedures, including the number of patients who lived/died, and proper preparation of patient for appearing before the “death panels?”

Obviously, nothing but a hands-on approach could effect the proper grades for the physicians. Consider the bureaucrat observing a heart bypass operation despite the fact that he doesn’t know a respirator from an ATM and wonders if the doctor is in danger of freezing the patient to death in hugely lowering his temperature, standard procedure. A grader, probably in disguise, will have to be in or preferably near the hospital nurse-stations to observe physician behavior, with an especial eye to harassment, discrimination, and proper completion of forms, not to mention off-color or ethnic jokes in case someone is offended.

PQRI is an idea that should never have come, an absolute absurdity. The paperwork alone would be monumental, causing a huge increase in what doctors already have to charge in order to hire the huge staffs to handle it. To have government bureaucrats determining the amount to be paid case-by-case concerning Medicare patients is unthinkable. This is regulation carried to a degree unimaginable in a democratic society, clearly driving the health-care system into a socialistic venue, which has always been the goal of President Obama. One can expect that all the thousands of new workers will be unionized as Obama’s debts to union money and warm bodies slaving on the campaign trail will be discharged.

Regulations by czars such as those concerning the proper light bulbs and the proper structure of processed foods, and presidential executive orders such as the assault on Libya resulting in no one knows how many civilian deaths have been the name of the game during Obama’s tenure. The republican candidates are railing against this takeover of the country by stealth, and they’re right. The time has come to put a stop to it and hopefully that will happen in November with respect to both the unbelievably weak Congress as well as the presidency. If this doesn’t happen, this nation will join olde Europe in heading for the ash-heap of history.

And so it goes.
Jim Clark

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