High-quality care can mean many things. In the ideal sense, it conveys cooperation and coordination between the many facets of healthcare delivery – great physician care, the best possible translation of medical evidence to an individual patient, outstanding nursing, electronic systems that double-check and triple-check for safety, and an army of staff to support patients in all settings to ensure best possible health.
Or, high-quality care can just be a number. A surrogate number, obliquely related to the ideals of quality care. And the penalty for bad care can be monetary, a decrease in the level of reimbursement to a hospital. Reimbursement, that, paradoxically, could be used to increase the quality of care.
And, so we see this paradox playing out in Detroit, as this letter in the NEJM points out. Detroit, suffering publicly through bankruptcy and infrastructure collapse, simply does not have the resources to support public health. Thus, its citizens, with poor access to preventative and primary care, and already burdened by the misery of the City, are forced to seek care – repeatedly – in its metropolitan and inner-city hospitals. And, because of such repeated visits, these hospitals are subject to the Medicare Readmission penalty – and thus, fewer resources with which to care for those lacking adequate support to care for themselves outside the institutional setting. And around we go again.
Are we truly measuring and encouraging quality? Or are we punishing those systems who simply cannot afford to be further stressed?
“Medicare Readmission Penalties in Detroit”
http://www.ncbi.nlm.nih.gov/pubmed/25207786