As part of the Affordable Care Act, the federal government adjusts reimbursements to health-care providers up or down based on the quality and cost-effectiveness of their services, as measured by a set of standards established by the Centers for Medicare and Medicaid Services (CMS). The standards use metrics such as how long emergency-room patients must wait to be seen and how long it takes heart-attack victims to get stents placed in their blocked arteries. The intention is to encourage savings and sound practices and enhance patient satisfaction.
The problem is that these requirements have not only increased costs but also may promote poor practices. For example, the CMS goal of stenting a blocked coronary artery within 90 minutes of a heart attack has not been shown to decrease mortality. Moreover, rushing a chest-pain patient to surgery to meet an arbitrary time goal may increase the odds of misdiagnosing other life-threatening conditions such as tears in the aorta, the main artery carrying blood from the heart. Before the imposition of the 90-minute rule, doctors routinely took x-rays of patients with chest pain looking for an aortic rupture. Its presence is a contra-indication to the blood thinners routinely given to heart attack victims. Chest x-rays are no longer recommended by some cardiologists because they prolong the work-up by a few minutes, making it more difficult to meet the 90-minute goal. “Sometimes I just need five more friggin' minutes,” said one presenter at a medical conference.
