The government agency that's holding our hospitals hostage

I have been a physician for 43 years. This has instilled in me a sense of duty and compassion for those who are suffering. I am politically liberal and believe that government has a place in our lives. Government's obligation is to ensure justice. Reciprocally, I have a duty to ensure that government is just. That being said, I want to bring to light a government agency that appears to be unjust and out of control.

The Centers for Medicare & Medicaid Services, or CMS, is a federal agency within the U.S. Department of Health and Human Services that administers the Medicare program.

Part of CMS's responsibility is the evaluation of hospitals. It has the power to decertify a hospital as a Medicare provider. Loss of this certification would be a financial disaster for any hospital and it is unlikely that a decertified hospital could survive.

Government has a role in maintaining hospital standards. Unfortunately, I have too often seen CMS in operation. It is now operating more as an agency extorting hospitals to comply with nonsense regulations that do nothing to improve patient care.

Let me give some examples:

* CMS requires that all medication orders state the route of administration, even when there is only one available route; e.g., if I write an order for metformin but do not state "by mouth," this results in a violation even though there is no other way to give this particular medication.

* CMS requires that all notes be time-stamped. If I see a patient and write a progress note, a set of orders, and sign two or three phone orders but miss placing the time on any one of these, it is a violation each time I fail to write down the exact time.

* CMS requires that all angiographic procedures be done with the doctor in complete scrubs including a cap and mask. When I asked why this dress code is now necessary, I was informed that it is a CMS mandate to prevent infections. In 40 years doing angiograms without scrubs and mask, I have never had an infection. Furthermore, I cannot find anything in the medical literature to support the contention that there is any difference in the infection rate between scrubs and mask and no scrubs and mask. When I point out that angiographic procedures are done with the patient awake and that being able to see their doctor's facial expressions is often comforting and anxiety-lessening to the patient, no one seems to care.

* CMS has given the hospital violations for using traditional Latin abbreviations. For example, the Latin abbreviation "QID" means "four times a day." Now if I am writing multiple medication orders, it is a lot faster to write QID than "four times a day." It is also a CMS violation. CMS does not care that there is no evidence to support that the using of the long English form would provide any benefit in patient care or that using the traditional Latin abbreviation would be harmful. It is just a violation if not done their way!

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These are only a few examples that affect me as a physician. There are many more that affect nursing staffs and every department in the hospital. I have seen these intrusions affect nursing morale and consequently result in the dumbing-down of patient care. The nurse becomes more concerned about the paperwork than changing the bedpan! I have repeatedly asked why the hospital administration does not challenge CMS's ridiculous insistence on form rather than substance. The answer is always the same: "We cannot run the risk of offending CMS and losing our Medicare approval. Doctor, you just need to be quiet until this survey is over."

These surveys are never over. CMS comes out and cites the hospital for several violations. It demands a correction plan from the hospital. CMS then comes out another time to resurvey. Of course, it finds more violations.

In my experience I have never seen CMS teach the hospital anything to improve patient services or care. It is always about nonsense violations and its threat of withdrawing Medicare approval. So the hospital just keeps putting more pressure on the staff. I know of at least two Bakersfield hospitals that have submitted to this extortion.

It is time to demand justice from the government. This unjust CMS burden placed on hospitals and their medical staffs needs to be investigated and stopped. CMS needs to understand that patient outcome is more important than the occasional lapse in paperwork.

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Dr. William D. Bezdek has practiced cardiology in Bakersfield for more than 35 years. He is a fellow of the American College of Physicians and a fellow of the American College of Cardiology

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