Pneumonia, antibiotics, and CMS

This is the text of an email I got from one of my professional societies, AAEM.  I’m copying it here, and highlighting some of the text, to support a minor rant to follow:

AAEM Update from Dr. William Rogers of CMS (speaker at the 2005 Scientific Assembly):

Thanks to AAEM for inviting me to speak at the annual meeting. The dialog was valuable to me and I am committed to helping enforce the CMS requirement that physicians have access to information concerning billing for services they render. I must apologize for a HUGE mistake I made in responding to a question concerning "four hours to administer antibiotics for pneumonia." I said that CMS was not going to define a time period within which antibiotics must be administered to patients with pneumonia in our hospital quality measures and I was wrong. We have defined the acceptable time period as four hours. These measures will change over time and I am well aware of the challenge that many EDs will have in meeting this target. To the extent that the target encourages hospitals to make investments which will reduce waiting times and allow for more timely treatment; the goal will be serving a useful purpose. I am concerned that some overwhelmed emergency departments will resort to creative strategies to improve their scores which won’t really improve the quality of care; an approach which should not be encouraged. If the Physicians Regulatory Issues Team at CMS can be of help to the AAEM in any way, please call or email us.

William D Rogers, MD FACEP
Medical Officer, Office of the Administrator Director, Physicians Regulatory Issues Team Center for Medicare and Medicaid Services

The bold text has to do with getting antibiotics into patients with pneumonia within four hours of diagnosis of said pneumonia.  Sounds easy, right?  Well, the patient is seen, and the clock starts (I think, please correct me if the clock starts elsewhere).  It takes time for the xray order to get entered, for the patient to get an xray, for the doctor to be aware the xray has been taken, the xray to be seen by a doctor, find the chart, write an order for antibiotic, nurse gets chart, gets antibiotic, and starts it.  In a perfect world that’d take 30 minutes, tops.  I don’t know any ER doc who works in a perfect world.

The underlined text is what burns me up right now.  Deadlines can make hospitals make investments, but since CMS has decided to use the WalMart version of financial management, ie, pay a little less every year, where will this money come from?  Yes, we’re going to be forced to be ‘creative’ in the face of losing medicare funding.

Medicare (CMS) has the authority to withhold money if their goals aren’t met, so there’s a lot of emphasis on meeting the target.  However, eventually medicare payments will get low enough it won’t be wort the effort.

And that’s when the fun starts in healthcare financing.