Government Mandate to Doctors Could Harm Some Patients

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.

"This is 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.

“Physicians 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. Weltge.

"Routine 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. 

The Texas 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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Last Updated On

November 10, 2016

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