My good friend and mentor, Ray Delisle, used to say that the truth was always in the middle. Keeping in mind that the "middle" can be as large or as small as we want it to be, it's a pretty good adage to follow. For some reason, during my bike ride today, I was thinking about truth. Why did this topic come up? Because I can never let myself get away from thinking. It's what I do. I like to think. I like to think about the topics that have meaning to me and to which I've devoted most of my career. I've written some articles in the past year for a long term care news outlook. I'm starting to think about my next topic, and I think that topic has to do with the truth. We are bombarde on a daily basis by people who want to define the truth to us. Their motives matter, because the truth to them is only what supports their goals and mission.
A few years ago, Sylvia Burwell, Secretary of Health and Human Services at the time wrote an article in the New England Journal of Medicine about the governments push to bring quality to health care by way of value based payment. It was bullshit. At the time, I wanted to write an opinion piece, but I was working for a quality improvement organization at the time and decided it probably wasn't wise to do so. Let me be more specific. She talked about a goal to have 90% of fee-for-service Medicare payments tied to quality or value by 2018. This sounds great. But what does it mean? It means that doctors were being required to add some codes to go along with their service codes when they billed Medicare. These codes had some tie-in to so-called quality measures. To the lay person, this might sound like the government was essentially linking its physician payments to value or quality. What they were actually doing was adding extra work, not necessarily related to any evidence-based approaches to improving quality. The government wants us to believe that they're working in our best interests. Sometimes they do, but this was, and to a large degree still is, just smoke and mirrors.
The nursing home industry would like you to believe that they have the best interests of the residents in mind. This, by and large, is bullshit. The owners of nursing homes throughout the United States care about one thing and one thing only, money. That money is embedded primarily in the real estate that houses the most frail and vulnerable members of our society. I am all too aware of the decisions that go on behind the scenes that have a direct impact on the care delivered in nursing homes. One would think that decisions regarding patient admissions should be made based on what is in the best interests of the patient. Nothing could be further from the truth. It is rare that anyone with the necessary clinical skills to understand a highly complex patient population has anything to do with nursing home admission decisions. In fact, sometimes, an owner might shift admissions to a specific facility in order to enhance that facilities numbers in order to get a loan based on the real estate. That's what really drives the long term care industry.
If the government has its own version of the truth, and owners of nursing homes have their version of the truth, what does that mean for the folks living in nursing homes? It means that they need someone to tell the truth. Sounds like the focus of my next article.
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