The Age of 'Regulopathy'

September 22, 2013

Perhaps it would be better to put doctors in charge of patient care, rather than paint-by-number regulations.

I must give credit to the September edition of the American of American Physicians and Surgeons (AAPS) Newsletter, for directing me toward my new favorite "neologism," which is in turn borrowed from an article in General Surgery News entitled, "Petting the Tiger: The Age of Regulopathy":

"In the Age of Regulopathy, hospital routine must include exercises like daily Foley Rounds, writes assistant professor of surgery Peter K. Kim, MD, of Albert Einstein School of Medicine. Whenever one is found, 'a cracker-jack team of simulator-trained and credentialed experts arrives to deactivate the Foley catheter before the clock strikes 48 hours post-op. Surgical Care Improvement Project(SCIP) triumphs again, and a potential UTI has been averted.'  

"But there are consequences. The urinary tract infection rate went down, but so did the Foley catheter day (FCD) denominator, so the UTIR/FCD rose and had to be reported, Kim writes. Also, central line infections went down because central lines were removed, but patients became malnourished and wounds dehisced [burst or opened at the incision site]."

The basic thrust of the article suggests perhaps it would be better to put doctors in charge of patient care, rather than paint-by-number regulations, which results in a daily catheter hunt, as if Foleys were pythons. So why do we have these SCIP regulations?

A good starting point is the Deficit Reduction Act of 2005 (DRA) which requires a quality adjustment in Medicare Severity Diagnosis Related Group (MS-DRG) payments for certain hospital-acquired conditions.(Translation: CMS announced it would no longer pay for hospital-acquired infections, so hospitals better think of something quick.) The Joint Commission sprang into action and determined hospitals could save as much as $1 million in unreimbursed costs due to infection, if all Foley catheters were removed within 48 hours post op, regardless of need, or even consideration of the actual patient’s condition.

The SCIP process was explained, according to the Joint Commission’s website. SCIP is a national quality partnership of organizations interested in improving surgical care by significantly reducing surgical complications, and was created in partnership with the Steering Committee of 10 national organizations who have pledged their commitment and full support for SCIP.  (Translation: The Joint Commission thinks "regulopathy," or the loss of physician autonomy, should be much more acceptable because a group of 10 national organizations have pledged to create a system which they can present to CMS as the method which best strips physicians of their autonomy.)

It is normally about this time in a seminar presentation, I post on a PowerPoint screen the very first promise Congress made to physicians in the opening paragraphs of the Medicare Act. And I simply sigh, as further words seem superfluous:

42 USC § 1395 - Prohibition against any Federal interference

"Nothing in this subchapter shall be construed to authorize any Federal officer or employee to exercise any supervision or control over the practice of medicine or the manner in which medical services are provided, or over the selection, tenure, or compensation of any officer or employee of any institution, agency, or person providing health services; or to exercise any supervision or control over the administration or operation of any such institution, agency, or person."