Reduction of Central Venous Catheter Use in Medical Inpatients Through Regular Physician Audits Using an Online Tool

unintended consequences due to these in-office payment reduction policies through shifting the performance of these procedures to the hospital environment, with the associated hospital outpatient department payment formula, at a substantial increase in cost to the CMS. White and Wu2 have examined Medicare hospital cost reports for the period 1996-2009 and concluded that Medicare price cuts yield revenue reductions that are even larger than the Medicare payment reductions—in other words, other payers also reduce payments and affect downstream revenues. In addition, Wu and Shen3 have demonstrated that drastic reductions in Medicare payments can potentially have an adverse effect on quality of patient care. Lindrooth and colleagues4 studied 30-day mortality from Medicare databases for the years 1997, 2001, and 2005 and have reported an inverse relationship between changes in profitability and mortality across 21 service lines. Many would view that it is speculative to suggest that reducing payments will lead to an adverse effect on quality of care, but the analyses of Wu et al and Lindrooth et al at least beg the question of whether better strategies for imaging cost containment could be implemented by the CMS. The current health care delivery challenges and resultant changes to the practice landscape demand creative and workable solutions to meet the needs of new practice models as well as help current private practitioners maintain viability while simultaneously promoting high value in health care delivery. These changes include a renewed focus on new payment models, education around evolving models of care, developing and using quality tools to ensure evidence-based care, and promoting the appropriate use of stretched resources. In particular, addressing the problem of overuse of unnecessary tests and procedures by implementing payment models that encourage appropriate testing while discouraging inappropriate testing is a more rational approach for controlling Medicare costs than across-the-board decreases in reimbursement. Physicians will need to assume leadership in new delivery systems and health care policy to encourage all specialties to practice cost-effective medicine. We agree with Fuchs and Milstein5: “There is not much that physicians can do directly to change the behavior of insurance companies, employers, or other stakeholders, but physicians are the most influential element in health care. The public’s trust in them makes physicians the only plausible catalyst of policies to accelerate diffusion of costeffective care.”