Has Congress Heard of "Evidence Based Medicine"?

The health care reform "point" people, Democratic Senators Max Baucus of Montana and Republican Charles Grassley of Iowa, have made several questionable proposals. These include supplementary payments to doctors who regularly exceed "national benchmarks" for care quality, bundling all services provided to a hospital patient (including such small items as nursing home care), a boost in payment to hospitals that provide superior care for heart attacks and failure, pneumonia and certain other conditions, and more money to doctors who hire nurses to manage follow-up care for Medicare patients post hospital-discharge with diabetes, asthma, depression and coronary artery disease. Harking back to the disastrous days of Health Systems Agencies ("HSAs") with an emphasis on saving money by inappropriate rationing of health care access to modern technology, Baucus and Grassley apparently also favor national standards for diagnostic imaging services.

The questions for the two senators include: (1) "what evidence supports the appropriateness of these proposals"? (2) What are the likely downside risks to their adoption? and (3) who will be among the health care casualties if these bureaucratically oriented proposals are adopted? What evidence is there that bureaucratic benchmarks for care and diagnostic procedures improve health care? Isn't there evidence already, that physicians who provide care to diabetics provide better care if they are not computer-dependent?

In this zero-sum era, adoption of these proposals will cause physicians, health care systems, and hospital managers to think hard about whether they wish to undertake the care of really sick patients or whether it would be smarter financially to dump these patients on their competitors or university centers. Medicare patients who are now having difficulty getting to see their physicians may find their situation deteriorating. But then again, death does put an end to complex really sick patients' health care costs, doesn't it?