Medicare recently announced it will start paying more to hospitals that follow a dozen procedures, including administering antibiotics prior to surgery and anti-clotting medication to heart attack patients. It will pay less to hospitals that don’t comply. The same thing is about to happen to doctors. Those who comply on up to 194 different metrics - including adopting electronic medical records — will get higher fees. Those who resist will get lower ones. These are examples of a much larger trend: Washington telling the medical community how to practice medicine. Even though a recent study finds little relationship between the inputs Medicare wants to pay for and such outputs as patient survival, and even though the latest pilot programs show that paying doctors and hospitals for performance doesn’t improve the quality, we are about to usher in the era of big brother medical care.
To its advocates, care that follows medical treatment guidelines and protocols developed by experts, based on the scientific literature — as reported in medical journals and scholarly reports — is “evidence-based.” If all doctors follow the same protocols, they argue, patients with similar conditions will be treated the same way. Wide variations in the practice of medicine would be replaced by uniform, standardized treatments. This view is about to dominate the entire health care system.
Ultimately, if you are elderly or disabled, Medicare will probably refuse to pay for any procedures that do not conform to the government-approved protocols. If you get health insurance at work, your employer will probably do the same. If you buy your own insurance, you won’t have much choice about the matter. The only health insurers that will be allowed in the new (ObamaCare) health insurance exchanges — certainly the only ones that survive — will be those that limit coverage to officially sanctioned, evidence-based care.
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