Over the years I’ve seen a lot of this. Health care organizations as a whole and administrators bending or breaking the rules of what’s ethical in order to meet some quality measure set by CMS, MDS, JCAHO, etc so they can get their gold star, five stars, approval, blah blah blah. Some of issues I’ve come across recently have been blood pressure targets that don’t take into account whatsoever the patient’s background: “We brought the patient back for a blood pressure check because their top number was high” “They’re a medically fragile 91 year old who’s 2 points over her target with cognitive impairment, no home support, already taking 10 medications, and their diastolic is in the high 50’s we’re not doing any additional medication” “Ya but it counts against your numbers and our quality measure.”
Another one is antipsychotic use in rehab facilities: “I recommend a low dose antipsychotic since the patient has had good response to this one in the past.” “We’d prefer it you didn’t prescribe antipsychotics since bipolar disorder isn’t an approved CMS/MDS diagnosis and it’ll count against us. Have you tried some other antidepressants.” “I don’t think you understand bipolar disorder and we’ve tried a lot of other things already this is it for options.” “We’d still prefer you don’t prescribe it.”
And recently I overhead talk of administrators passively suggesting to clinicians to just diagnosis them with schizophrenia so it doesn’t count against them.
What it is this shit? It’s incredibly unethical and unsafe. Has anyone else experienced this? Who are we supposed to report it to when the very organizations putting forth these measure are the ones that are supposed to be safeguarding patients?
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