Medicare aims to zoom in on hospitals, suffocating them with a variation of the absurd pay-for-performance charade that will soon torture practicing physicians. Of course, a little torture is okay, as our government contends, but pay-for-performance won’t increase medical quality, at least as it currently exists. It can be defended as a job creator as several new layers in the medical bureaucracy will be needed to collect and track medical data of questionable value.

Medical quality simply cannot be easily and reliably measured as one can do with a diamond, an athlete or a wine. Most professions resist being graded or claim that the grading scheme is a scheme. Teachers, for example, refute that testing kids is a fair means to measure their teaching performance. Conversely, any individual or profession who scores well on any quality review program will applaud the system’s worth and fairness. Shocking.

Under the government’s new program, hospitals could be financially responsible for the cost of medical care that a patient requires for up to 90 days after discharge. One can imagine why this provokes angst with hospital administrators. It’s easier to defend the government’s concept if a heart attack patient is discharged prematurely and is readmitted two days later with congestive heart failure. The case is harder to argue is a stroke patient falls at a rehab facility 2 months after discharge and needs to be hospitalized. There will be spirited arguments as to whether the post-discharge events were preventable by higher quality and better coordinated out-patient care. Paradoxically, it might influence hospitals to prolong discharges, which increases costs and the risks of various hospital adventures, including infections and C. difficile colitis.

Government lexicographers have concocted a new phrase, ‘Medicare spending per beneficiary’, which will be used to compare costs among hospitals caring for the same types of patients.

How much responsibility can fairly be assigned to hospitals for bad stuff that happens once patients are released? If a medical event occurs at the nursing home, for example, would this be the hospital’s fault or the nursing home’s? It will be fun to watch the two institutions, who both champion patient care, duke at out. Cash breeds competition.

One item is beyond dispute. It’s a lot easier to measure cost than medical quality. I fear that many of these quality initiatives are veiled attempts to save money, but are camouflaged as medical quality incentive programs.

The ironic flaw in all of this is the absence of any quality control over pay-for performance and its cousins who claim they can raise the medical quality bar. I wish there was a way that we could pay these guys depending upon their performance. The government would resist this as it would be a job killer when all of these newly hired bean-counting bureaucrats would lose their jobs.

Ronald McDonald to stay: Fast food giant McDonald’s chief executive Jim Skinner informed shareholders Thursday that the iconic Ronald McDonald is “going nowhere.” His answer was in response to a letter sent to the company by more than 550 health professionals and organizations asking it to stop marketing junk food to kids and retire Ronald McDonald.

Baby products contain flame retardants – A team of scientists found “potentially toxic” amounts of eight flame retardants in 80 percent of polyurethane foam samples from common baby products like car seats, mattresses and nursing pillows, according to a study published in the journal Environmental Science and Technology.

HHS imposes new rules on insurers: The Department of Health and Human Services established a final rule by which insurers who are thinking of hiking their rates by more than 10 percent will need to justify those increases starting September.

Can coffee lower risk for prostate cancer? A study published online in the Journal of the National Cancer Institute found that the mix of antioxidants in coffee may lower the risk for prostate cancer in men. Researchers at the Harvard School of Public Health observed 47,911 men for 20 years and found that men who drank the most coffee (six or more cups per day) had an 18 percent lower risk of developing any form of prostate cancer and were 60 percent less likely to die of it.

FDA pulling Avandia off U.S. shelves: The U.S. Food and Drug Administration has decided to pull the diabetes drug Avandia from retail pharmacies effective Nov. 18. A study published in 2007 found that people taking Avandia had a 40 percent increased risk of heart attack. The drug will be only available through a mail order program for patients who have been safely using the drug, those who have had no success in controlling their blood sugar with other diabetes medications or patients who are aware of the drug’s risks.

• Identify which two of the three individuals listed below are cigarette smokers. John Boehner, newly elected Speaker of the House , 3rd in line to the presidency
• Barack Obama, Commander-in-Chief and leader of the free world
• Michael Kirsch, Hemorrhoid examiner

I’ve never smoked and I detest the habit. It kills people and separates lower income Americans from money that could likely be devoted to more worthwhile endeavors. I remember caring for folks with end stage emphysema as a medical resident and thinking that this disease was worse than cancer. I haven’t changed my mind.

Yet, I have felt for years that Big Tobacco is demonized by the press and the government as Big Scapegoat, and this blame shift has always troubled me. I am well aware that the tobacco companies are guilty of many offenses. They have lied about their corporate practices, advertising strategies and manipulation of nicotine content. These companies — like any individual or business — should be held accountable with available legal remedies. If crimes were committed, then I’m sure this nation has a few idle and altruistic attorneys who can fight them in the courts.

My quarrel is blaming these companies for the decisions that individual smokers have made. Assuming that every nefarious allegation against the tobacco companies is true, and throw in a few more, it doesn’t change the fact that smokers for several decades knew (or should have known, a favorite lawyers’ phrase) that cigarettes steal life and breath. This was common knowledge even before cigarette warnings appeared on cigarette packages. I think it an abuse of the justice system and an assault on morality when an individual who is suffering a horrible consequence of a habit that he freely began, blames the manufacturer for his misery.

We all remember the billion dollar settlements that the tobacco companies paid to the states, ostensibly to be used to reduce cigarette use, but were largely devoted to general operating expenses. The phrase “up in smoke” applies here.

While I personally oppose the habit, and counsel my smoking patients to cease and desist, this is a free society. Folks can choose to engage in a variety of activities that span the risk spectrum.

In my state of Ohio, it is legal to

• Ride your motorcycle in the rain without a helmet
• Become an alcoholic
• Flush your life-saving medicines down the toilet
• Hunt
• Ski on a Black Diamond path when you should be on the Bunny Hill
• Gorge yourself on a diet of crème brulee, cheesecake and assorted deep fried delicacies

The federal government has issued new regulations that will require cigarette manufacturers to incorporate new labels that will cover half of the cigarette pack or carton. These 36 color photos will be graphic and ghastly portrayals of the ravages of nicotine addiction. The labeling will be a veritable slide show of horror, including a corpse with a toe tag, a man blowing smoke out of a tracheostomy hole in his neck and a wasted and cadaverous individual who looks too weak to lift his last cigarette.

Cigarettes must not be entirely evil, or else the government would outlaw them. Here are some pesky realities that anti-tobacco company zealots must overcome.

• The product is legal
• Tobacco directly and indirectly creates jobs and income in all 50 states
• Smokers pay a fortune in taxes to the states and to the federal government
• Many smokers enjoy the habit

Don’t misunderstand this post. I will never smoke and hope that no person I care about will pursue this habit. I encourage all inhalers to exchange their habit for a more salubrious addiction. What I do oppose is blaming tobacco companies for the woes of their customers. I also am uncomfortable with the government slowly suffocating these companies who are entitled to advertise and sell their legal wares. If, as a matter of public policy, cigarettes’ adverse health consequences outweigh their economic benefits and the rights of smokers, then have the guts to outlaw them outright, rather than incrementally bleed the companies.

If you support the government’s strategy of pursuing the demise of Big Tobacco by a thousand cuts, then who will be the next targets? Should every product that is not on an approved health and wellness list be attacked? Who decides which companies and activities should be on the list?

Beware! We may soon see similar scenes of ghoulish horror on Hershey bars, Frosted Flakes and even Twinkies. Ronald McDonald will be behind bars, wearing a different set of stripes. Sesame Street’s Cookie Monster will be in shackles.  When you pop a champagne cork at your next family celebration, the label won’t be a pastoral scene of a vineyard, but will be a jaundiced alcoholic vomiting blood.

I’m not scared of the government’s new cigarette horror show. I’m scared it won’t end.

Dr. Michael Kirsch is a practicing physician and writer who blogs as MD Whistleblower.

Dr. Robert Cohn, right, examines a patient at MetroHealth's Children's Hospital

CLEVELAND, Ohio — MetroHealth Medical Center is close to opening a Ronald McDonald Family Room — a feat of fund-raising success at a time when raising money is as tough as the economy.

A vision of  Dr. Robert Cohn, chairman of pediatrics at MetroHealth’s Children’s Hospital, the family room and its comfortable chairs, computers and snacks is designed to provide a respite for families of sick children who are visiting the hospital.

“Dr. Cohn really got it started,” said Dave Jacobs, a vice chairman of the MetroHealth Foundation, which raised $128,500 to build the family room. “They’ve been working at it for a couple of years now and were waiting for the funding.”

Jacobs, who also is chief operating officer for Oswald Companies, the Cleveland risk-management firm that specializes in employee health insurance plans, said reaching a fund-raising goal is gratifying — especially during a recession.

“It’s very difficult in this environment to raise money,” he said. “So the fact that we were able to accomplish this particular vision for Dr. Cohn was really exciting for us.”

Money to build the family room on the fourth floor of the hospital’s tower building came from foundations, corporations and individuals, Jacobs said. Life’s A Snap Foundation, headed by Kevin and Kristen Houser, led the giving, he said. Kevin Houser has played in the National Football League since 2001 and he and his wife, Kristen Houser, grew up and were high school sweethearts in Westlake, Ohio, she said.

The Housers also helped raise money for MetroHealth’s pediatric comprehensive health program.

“While it’s important for the children who are affected by these various illnesses to have strength and support from their families, we believe that it’s equally important that families who are at the hospital every day … feel supported … and have a place to go in tough times to spend time together,” Kristen Houser said.

The Ronald McDonald Family Room at MetroHealth will be the fourth among Greater Cleveland hospitals, said Diane Weiner, family room coordinator for Ronald McDonald House of Cleveland. The other three are at University Hospitals, Cleveland Clinic and the Clinic’s Fairview Hospital, Weiner said.