Alan Zarembo reports in the Los Angeles Times that “Heart attack patients in states that require health care providers to report the outcomes of procedures to open blocked arteries are less likely to receive those live-saving treatments than patients in states without reporting mandates, according to a new study. “  Dr. Hitinder Gurm at Michigan University said the study reported in JAMA raised concerns that doctors, under pressure to keep their success rates high were avoiding or denying care to the sickest patients.  Dr. Karen Joynt of Boston who led the study said the “buzz” among cardiologists “was that some doctors were not operating on patients with the lowest chance of survival.”

Is this a sliver of truth leaking out, a view into how the easily defended “quality reporting mandates” have already morphed into rationing of care to the sickest patients?  If so, this is purely unintentional on the part of the AMA’s flagship journal, as this is essentially a government-funded organization.  If, however, this is a rare view behind the curtain, I predict that we will see nothing further from Dr. Karen Joynt!  Hopefully she will not suffer the fate Dr. Eric Topol did at the hands of the Cleveland Clinic.  Hats off to her for doing this study. 

At the risk of saying “I told you so,” I’ll say it.  Readers of this blog are familiar with this “unintended consequence” of mandatory quality reporting, it’s implementation resulting in rationing to the sickest patients, as physicians, “paid for performance,” alter their actions to……maximize their performance!  Watch, in addition, for droves of patients not needing coronary artery stents at all to get them as these patients tend to do the best.  

Once again, any time the government gets involved in anything, the resulting disturbance in the free and unfettered market is predictable.  In the health arena, this initially means prolonged suffering and agony from denial of care.  Later, these patients will become, like sick British patients, targets for euthanasia, the “greater good,” rather than the interests of the individual patient guiding the “policy makers.” Many suffering patients will beg for their deaths and societies bankrupted by government health care will oblige them.  The time to turn around and change direction is prior to arrival at the destination.  Like it or not, we are well on our way. 

G. Keith Smith, M.D.