Texas Physicians Seek to Remedy Errors
Nov. 10, 2016
The federal government
currently requires physicians to perform a medical procedure on patients to
help them, but the procedure can instead cause serious harm to some, so Texas
physicians are fighting to get the government to
rescind the directive.
If the doctors don’t follow orders, they and the hospital where the care takes
place risk a poor grade.
nonsense,” said Arlo Weltge, MD, the Texas Medical Association (TMA) physician
leader who is raising the call for a solution. “This has the unintended
consequence of requiring a physician to harm the patient or be penalized for
not complying with the government mandate.” Dr. Weltge, a member of the Texas
Delegation to the American Medical Association (AMA), is taking a resolution
addressing the problem to this week’s AMA policymaking meeting.
The issue at hand is a mandate requiring
physicians to give patients with potential serious infections “resuscitation
with 30 ml/kg crystalloid fluid” (saline solution) regardless of their clinical
circumstance. Doctors who do not do so are docked in a government care-quality
scoring system. The hospitals in which the patient receives treatment receive a
bad score as well. This is one of several care mandates the federal Centers for
Medicare and Medicaid Services (CMS) gives physicians who treat Medicare
patients. CMS oversees the care Medicare patients receive from physicians,
hospitals, and pharmacies.
Dr. Weltge, who is an emergency medicine
physician in Houston, says the treatment for the infection can harm or even
kill patients with congestive heart failure, kidney failure, or liver failure.
Such patients often have too much fluid in their systems, so adding the
required fluid can cause harm. Dr. Weltge describes a typical patient in this
scenario might be a liver-failure patient who is already 'fluid overloaded,' throughout
his or her body, often with a bloated stomach full of liquid.
“Giving him or her the full amount of
fluid would cause acute respiratory distress and required intubation… meaning
doing so would cause the patient intentional harm,” he said.
The CMS requirement allows no
exceptions, leaving physicians caught between appropriate patient care and
hospital administrators’ push for top quality scores. The current CMS-mandated “Core Measures
Sets” quality-reporting system requires hospitals to penalize physicians for
not following the mandate, regardless of the patient’s condition.
“CMS has now over-stepped good
intentions by requiring specific treatment that can harm certain groups of
patients,” he said.
The resolution — backed by the 40-member Texas
Delegation of physicians and medical students — urges the AMA to formally
oppose CMS directives that can harm patients (such as this one), and warn
physicians and hospitals about the harm this directive could create. The AMA
House of Delegates governing body is scheduled to vote on the proposal during
this meeting, which takes place Nov. 12-15 in Orlando, Fla.
want to provide the best possible care to their patients, and certainly, the
federal government must make sure health care dollars benefit patients by
attempting to identify quality-care and effectiveness measures,” said Dr.
quality measures are great for routine patients but might be harmful to many non-routine
patients with other existing diseases. As guardians of our patients’ care, we
must be able to take that into account," he added.
Delegation to the AMA is made up of 40 physicians, residents, and medical
students from across the state who serve as delegates or alternate delegates. They
practice in and around Austin, Dallas/Fort Worth, El Paso, Houston, Lubbock,
Nacogdoches, San Antonio, Temple, the Rio Grande Valley, and Tyler-Longview. Together
with the fellow delegates from across the nation, they debate and adopt policy
directing the AMA’s actions.
TMA is the
largest state medical society in the nation, representing more than 49,000
physician and medical student members. It is located in Austin and has 110
component county medical societies around the state. TMA’s key objective since
1853 is to improve the health of all Texans.
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Contact: Brent Annear (512) 370-1381; cell: (512)
656-7320; email: brent.annear[at]texmed[dot]org
Marcus Cooper (512) 370-1382; cell: (512) 650-5336; email: marcus.cooper[at]texmed[dot]org
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