Study author, John Birkmeyer, MD, director of the Michigan Surgical Collaborative for Outcomes Research and Evaluation, thinks the experiment, which was performed with experienced bariatric surgeons in Michigan, can be easily extrapolated to other surgeries and subspecialties.
The strategy, however, raises questions about what hospital leaders, in their role as physician employers or peer reviewers for staff privileges, should do with this information once they find a performer who doesn't measure up.
5. DSH Reductions
It remains unclear how soon and how fast, and which hospitals with large populations of low income, uninsured or underinsured patients, will lose their federal Medicaid and Medicare disproportionate share funding. But under the Patient Protection and Affordable Care Act, there's a presumption that more patients will be covered. Therefore the need for DSH to help hospitals cover their costs of uncompensated care would drastically drop.
In a letter last month to key Congressional leaders, leaders of nearly 100 hospitals and health systems protested said:
"Cuts to Medicaid DSH have recently taken effect, reducing federal support for our hospitals by $500 million this year. These cuts will get much larger in the coming years if you do not act now. If these crippling cuts are not stopped, our hospitals will be forced to curtail essential services, ultimately limiting access to care and cutting jobs. There is no connection between the cuts and the number of uninsured or amount of uncompensated care across the country. The level of Medicaid DSH cuts simply cannot be justified."
Other issues with respect to DSH funds have to do with approved delays in federal requirements under the law, which may result in more people than anticipated remaining underinsured in 2014.