Metrics and Their Unintended Consequences
VA hospitals are judged by their outcomes, creating an incentive to turn away sick patients and admit healthy ones.
Photographer: Spencer Platt/Getty ImagesIn December, doctors at a VA hospital in Oregon decided to admit an 81-year-old patient. He was dehydrated, malnourished, plagued by skin ulcers and broken ribs -- in the medical professionals’ opinion, he was unable to care for himself at home. Administrators, however, overruled them.
Was there no bed for this poor man? No, the facility had plenty of beds; in fact, on an average day, more than half of the beds are empty, awaiting patients. Was there no money or medicine to care for him? No, and no. Reporting by the New York Times suggests that Walter Savage was, perversely, turned away because he was too sick. Very sick patients tend to worsen the performance measures by which VA hospitals are judged.