Is Medicare Paying for Performance? Or . . .

. . . is it simply not paying for mistakes? On its face, the forthcoming announcement that Medicare will stop paying for gross errors is long overdue (kudos to Robert Pear of the New York Times for breaking the story over the weekend). But let's not mistake this for a real pay-for-performance (P4P in the argot of health policy wonks) system. We'll know Medicare is serious about improving quality while holding down costs when the nation's single-payer health plan for seniors figures out why the elderly in their last two years of life spend twice as many days in the hospital in New York and Mississippi as they do in Oregon or Utah (for this and other eye-opening statistics on how the uneveness of care around the U.S. has nothing to do with medical outcomes, see the Dartmouth Atlas of Health website). . . Meanwhile, a new survey of 3,100 physicians shows that over 90 percent have been involved in a "near miss, minor or serious error," according to the Los Angeles Times, but less than one in five received training in how to report errors and just one in 10 said their organizations helped them cope with the stress that comes from making mistakes when peoples' lives are at stake. . .

Some interesting pushback in the Wall Street Journal today in response to the editorial page's latest blast in favor of cancer quackery. The letters in response to an op-ed calling for unrestricted access to drugs that pass early stage safety trials drew these retorts from physicians: "Asserting that because some patients get better after taking a drug it "obviously works" is a bit like asserting that because some seat-belted drivers die in car accidents, seat belts are obviously dangerous"; and "Phase 1 FDA drug trials provide ample evidence of a drug's ultimate safety(?) This is false. The scientific process is in place for a reason, and it takes through Phase 3 trials before we know if a new drug is equal to or better than the current standard of care." The one patient advocate whose letter made the paper had this to say: "As a 20-year cancer patient advocate I am forced to wonder why the Wall Street Journal continues to support this bizarre theory of a 'constitutional right' to investigational therapy." . . .

Are there ethanol pumps at your local gas station yet? A new study out of Great Britain, reported in the Guardian, says the rush to biofuels may do more harm than good in reducing carbon emissions. The reason? Researchers associated with the World Land Trust claim a major switch to biofuels will lead to deforestation in areas of the world like Brazil and Indonesia that are rushing in to feed this emerging "green" market. The authors of the study, writing in this week's Science Magazine (subscription required), conclude "policy-makers may be better advised in the short term (30 years or so) to focus on increasing the efficiency of fossil fuel use, to conserve the existing forests and savannahs, and to restore natural forest and grassland habitats on cropland that is not needed for food." Okay, help me out here. The farmers are for it. The conservationists are against it. Who's the honest broker in the ethanol debate?