Monday, August 20, 2007
"In one of the darker ironies in American health care, hospitals are often paid extra to treat the problems that arise when they make mistakes. Starting late next year, Medicare won’t pay for treatment for some conditions associated with screw-ups.
Under a little-noticed new rulebook that came down last week, Medicare will return the bill unpaid for care to solve these problems:
Two kinds of catheter-associated infections
Air embolism, or bubbles of air or gas entering the bloodstream during medical procedures
Mediastinitis (infection of the area between the lungs) after coronary bypass surgery
Giving patients the wrong blood type
Leaving objects inside surgery patients
The government estimates its direct savings at about $20 million a year, and Medicare has said hospitals can’t turn around and stick patients with the tab. Other insurers are likely to follow suit, and hospitals may well do a better job for all patients, not just those on Medicare, say some advocates of the new rules.
The American Hospital Association had proposed a narrower list, saying some bedsores and hospital-acquired infections occur even with top-notch care. The trade group wanted only “never events” — such as air embolism, blood incompatibility and leaving objects inside patients — unreimbursed.
Consumers Union, which has been campaigning for better control of hospital infections, generally applauded the new rules. “We think it’s going to be a very powerful incentive for hospitals to improve care, and also a way to contain costs,” spokesman Michael McCauley told the Health Blog."
Article printed from Health Blog: http://blogs.wsj.com/health
URL to article: http://blogs.wsj.com/health/2007/08/08/medicare-wont-pay-hospitals-to-remedy-flubs/
As one who's gone on record as supporting single-payer health care, this is the sort of thing that makes the position a little hard to defend. It's not that I entirely disagree with the concept. For one thing, I never (nor do most surgeons, far as I know) charged for a re-operation, even if it wasn't for an obvious error. Plus, I have advocated greater efforts to identify measures that some doctors take to get better outcomes, and to encourage them. So this sort of thing -- in theory -- is not unwarranted. The devilment is in the details. Some items on the list are inarguable; but not all. In particular, my ears up-pricked with the inclusion on the above list of mediastinitis. That happens, in this context, to be a particularly devastating infection that can occur after open heart surgery. If survived, the costs are likely to be huge. But here's the thing: there are steps we all take to prevent surgical infection; and we know that nothing is 100% effective. (The same can be said for certain kinds of air embolism.)
I can't say for sure, based on the articles I've read, but I infer these decisions will apply even if all appropriate steps were taken. Maybe there'll be fine print by which decisions can be appealed, but surely the bureaucracy will be daunting. I'm no heart surgeon; but wound infections can occur in any circumstances, despite the most scrupulous efforts to prevent them. What will be next? Orthopedic appliance infections (artificial knees, hips, etc) are awful occurances. Typical operating rooms in which they are implanted are cathedrals of carefulness: the operating teams can look like astronauts repairing the Hubble. Should a hospital that has gone to the expense of providing such a level of sterile isolation be penalized for the inevitable rare failure? Certainly, the patient will have suffered many consequences, and financial ones ought not be on the list. But hospitals have a hard enough time hanging in there financially already.
Without question, steps are needed to contain costs, and pressure to produce the highest possible levels of safety are justifiable -- more than that: they're required. It's one thing to penalize when failure to follow proper protocols occur. My concern is for events that happen when everything has been done right: there's simply no way to eliminate it completely. My prediction: once this policy is in place, we'll hear many examples of excellent care being penalized; and we'll see the list steadily expanded. It seems like the most fertile of soil in which to plant the seeds of unintended consequences. Time will tell.
[Unrelated statement: this blog seems to be experiencing an outflow problem. I'm of that age, of course; but I'm not sure the obstruction is amenable to the sorts of things a urologist might suggest. I could shove some Flomax up my nose, or into my ears, or sleep with it under my pillow. But I'm not optimistic. Just so you know.]