PSRO, PCA,
Daily Observer
Gautier grinned.
If there is such a thing as a malevolent grin, Gautier owned one. His waxed moustache pointed down while the
corners of his mouth creased an upward arc.
“You medicos will finally be put up against the wall,
now that HR 1 has been enacted to monitor the finances of the medicare and
medicaid laws. Are you going to join the
PSRO, Lapius?”
“You throw
initials around like any pretentious bureaurocrat, Gautier. Why PSRO?
Why not a PCA, or a
“What are they?
I’ve never heard of them,” Gautier said, his moustache wiggling a bit to
denote bewilderment.
“Well, then, Gautier, let’s not toss initials around
so pedantically. PSRO, of course stands
for the Professional Standards Review Organization. The other acronyms stand for similar
organizations.
These all flow from the Bennett Amendment to the
Social Security Act which says, in effect, that a physician has to justify
continuing a mode of treatment that extends beyond standards established for
the illness according to the patient’s age and diagnosis.
“Frankly, I don’t think it concerns me one bit,”
Lapius pushed his chair from the table, leaned back, and lit one of the large
black Havana cigars he imported from Nicaragua.
“Aha, typical doctor’s comment. Ready to flout the law,” Gautier said
gleefully. “Don’t come crying to me,
Lapius, when the government tries to put you in jail.”
Lapius snorted and blew a cloud of smoke that
enshrouded Gautier and started him sneezing.
“I’m not flouting the law. I’m not interested in Peer Reviews, not in
hospital bed utilization. My job is to
take care of my patients.
When they are hospitalized, I will keep them there
until I think that medically they are ready to go home. If the government chooses to cease payments,
that’s between it and the patient.
I inform all patients who have been hospitalized for
a protracted period that insurance might not cover extended stay and they may
have to meet the bill. They are free to
sign out of the hospital if they choose to.
But then they leave on their own responsibility.
I certainly won’t take the medical responsibility for
aborting their hospital stay if I think it’s risky.”
“But, Lapius,” Gautier became serious. He wasn’t needling now. “You have a responsibility to the
community. You can’t usurp beds unnecessarily—”
The word unnecessarily was a mistake. It
galvanized Lapius into attempting to stand up quickly, which involved a frenzy
of activity.
First his chair was too tight, then he was still too
close to the table. He shoved mightily
and the table slid away. When he
struggled to his feet the chair spun off his backside to land upside down. Lapius ignored it and turned to Gautier
“UNNECESSARILY?” he thundered. “Is it you, Gautier, who will determine how
long my patient stays in the hospital?
He’s not your PATIENT, or the GOVERNMENT’S PATIENT. As long as I’m the doctor he’s MY patient,
and I’ll brook no interference.
He can go home anytime he wants to; all he has to do
is sign himself out. I’ll inform him of
the risks. Don’t talk to me about
community responsibility taking precedent over the responsibility of a doctor
to his patient.
NOTHING takes precedent over a doctor’s
responsibility to his patient.”
“You’re too excited, Lapius,” Gautier cautioned. “But let me understand. Are you saying that doctors shouldn’t be
involved in the utilization review.”
“Precisely. This
isn’t oriented towards patient care. No
one is checking on the care given the patient by the doctors, the hospital, the
nurses. It’s strictly a watchdog
operation to govern finances. Who will patients sue if doctors become so
skittish by having someone look over their shoulders that they discharge
patients prematurely? The
Government? The PSRO? Not on your life. They’ll sue the doctor. And they’ll be right.”
“But Lapius, you know that hospital beds are over
utilized.”
“Listen, Gautier, you are a lawyer. What background in medicine, other than what
you’ve learned in your close association with ambulances, gives you the
expertise to judge complex medical problems?”
“But other doctors can judge.”
“No one can judge.
No one unless they know the patient, his disease, his family, the
accommodations at home, the temperament of the people he’ll be going home to,
the distance of the home from the hospital, the availability of outpatient
nursing service…
What gall to believe that an outsider can come in, whatever
his qualifications, and intrude on a doctor-patient relationship in such a
manner, merely to decide the merits of the case in relation to the costs the
government is willing to expend!
No, Gautier, doctors should not be concerned with
anything but that patient’s illness.
Anything else is a community problem.
Maybe the community needs more hospitals, more
extended care units. Maybe hospital
costs are too high. But none of these
considerations should be brought to bear on an individual illness.”
Lapius paused for breath, and then said sweetly, “But
we are old friends, Gautier. We
shouldn’t argue. Let’s change the
subject. What’s the current status of
no-fault insurance?”
Gautier turned pale.
The tips of his moustache trembled and twitched. He slammed his hand on the table. “What right has a government to decide that
there is no fault in an auto accident, or that a client isn’t entitled to
proper legal representation?”
“I’m not sure I agree with you, Felix.”
Gautier stood up, more gracefully than had Lapius
several moments before, walked up to the still-standing S.Q. Lapius and waggled
a finger under his nose. “You’re a
doctor, not a lawyer. What do you know
about legal matters? Stick to your own
profession.”
“I intend to,” said Lapius, “I intend to.”