The problems of not paying for Medicare errors

Suck it up, says an ivory-tower academic:

Nonetheless, even the best hospitals will have an occasional misstep. There is no reasonable way to make exceptions to the new policy, so hospitals will have to live with it.

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  • Anonymous

    It will make it impossible for the patient to divorce their hospital.
    Non-reimbursable error in hospital A. Hospital B certainly doesn’t want to take the patient without any reimbursement (they don’t even get the partial offset by having been reimbursed for the original care). Thus, the patient is stuck staying with the groups they might be dissatisfied with.

  • Anonymous

    This is how it works in the rest of the world. Mechanic screws your car up, they either fix it free of charge, or you go somewhere else and get it fixed and sue the mechanic for the cost of repair.

    Why does this shock any of you?

  • Anonymous

    There will be unintented consequences but it is postive first step towards minimizing the problem of bad care paying better than good.

  • Anonymous

    “This is how it works in the rest of the world. Mechanic screws your car up, they either fix it free of charge, or you go somewhere else and get it fixed and sue the mechanic for the cost of repair.”

    Because a human is not a car. A human was not designed/manufactured in a plant such that we know everything about the machine. We know a hell of alot more about auto’s than humans. Does that shock you? I am not justifying “never” errors such as wrong site surgery of leaving things in body cavities. I would postulate that a demented, bed bound, person developing a pressure sore and a superimposed MRSA infection, does not fall into that category.

  • Anonymous

    Since Dr Leape used extrapolated early 1980′s data for his 1999 to err is human paper and he doesn’t actually take care of patient’s, his opinion they laudable is suspect.

  • Anonymous

    ” I would postulate that a demented, bed bound, person developing a pressure sore and a superimposed MRSA infection, does not fall into that category.”

    And you’d be right. But that doesn’t address the issue. If it’s an error it’s an error. Now, you may debate how they define error, and that’s fine. But once we’ve agreed that it is an error, why should you be paid for fixing it?

  • Greg P

    The idea that this will improve patient care or patient satisfaction is not borne out by any data, since there is none. This comes from the idea of saving money, but it’s not even clear that it will do that.

    What we may see if anything is a patient “harmed” by some event, the hospital doing what it can to treat whatever, and the patient still suing in the end, since the patient says, “We’ll this is all well good enough for CMS, but what’s in it for me?” and the trial lawyers say, “Indeed, what’s in it for me?”

  • Anonymous

    Why shouldn’t the patients say that? After all, that’s what the physicians are saying.

  • Anonymous

    Because some amount of error is built in to any human endeavor and every physician who has ever lived has made errors? Oh, right, it’s lawyers who aren’t held to the standard of perfection.

  • Anonymous

    There seems to be the equation of poor result with error.
    Bed sores happen even with the best of care; Christopher Reeve no doubt had the best round the clock care that all his money could buy, yet he got be sores and died.
    Infections happen. Statistically, some infections are due to errors, since not following best practices can have higher infection rates than best practices. But note that there is a very real (and very deadly) infection rate even with best practices. Which infections were caused by which actions remains pure speculation.

    As a previous poster noted, there will be unintended consequences. The price tag to hospitals for caring for those patients at highest risk of complication will be seen as an even greater financial gamble. The 450 pound diabetic I took care of today who required 8 people to transfer him between beds reimburses the same as a normal patient with the same tibia fracture. It does not matter how much care we try to provide in the best manner, his complication rate is enormously greater than the normal 12 year old (that’s right, he’s only 12 and 450 pounds).

    If he has a complication of any sort, he can kiss health care anywhere else goodbye. As another poster above noted, there aint no hospital around who would voluntarily undertake any further care as there would be the possibility of receiving no pay at all if it were deemed that they were treating a complication from the first hospital. Bean counters will deny, stall, and obfuscate.

  • Anonymous

    “Because some amount of error is built in to any human endeavor and every physician who has ever lived has made errors? Oh, right, it’s lawyers who aren’t held to the standard of perfection.”

    What a stupid thing to say. And actually, lawyers are held to a standard of care also, and don’t have the locality rule.

    No one is saying it’s bad because you’re not perfect. Just that when you’re negligent you have to pay for the resulting harm if there is any. Why do you have such a problem with that? When you drive your car, if you hit someone because you ran a stoplight accidentally, do you think you shouldn’t have to pay for the harm?

  • Anonymous

    But studies have shown that the likelihood of being sued for malpractice, with the attendant expense and psychic pain, is as common for going through “green lights” as for going through “red lights”.

    Also, I note that a lot of states have implemented no-fault auto insurance – so they obviously think that you shouldn’t have to pay for your automotive mistakes.

  • Anonymous

    What study is that? What most studies show is that if you don’t want to be held financially accountable, communication with your patients is the key.

    If you want a no-fault style workers comp scheme, then advocate for it. You do understand that the standard for recovery will be lower, right? Like it is in workers comp – where you don’t have to show negligence, just that you were injured on the job.

  • Anonymous

    The “best and the brightest?” The highest median earners in the country? Those that are viewed by the masses with veneration bordering upon the superstitious? “Medicine, magic, miracles…” mistakes? Say it isn’t so! Deities do not make mistakes. It is a sacrilege to even suggest such a thing.

  • Anonymous

    “…just that you were injured on the job.”

    You don’t even have to show that. You just have to simply claim that you were injured on the job and have the WC parrot provider just readily sign off on the purported “history of industrial injury” BS that is being peddled.

  • Anonymous

    a demented, bed bound, person developing a pressure sore and a superimposed MRSA infection, does not fall into that category.

    What is a demented bed-bound person doing in a hospital? Is there anything that will fix them there? Are they confused and vulnerable to getting worse?

    Could they not be getting custodial care, and treating the bedsore in a nursing facility that would have some degree of normalcy for them?

    As a society maybe we have to come to grips with the notion that in some circumstances less is better.

  • Anonymous

    “What most studies show is that if you don’t want to be held financially accountable, communication with your patients is the key.”

    Just thought that deserved to be repeated.
    And if your Risk Management people object — ditch them. After all, they work for YOU.

  • Mike

    How are they going to know if its an error or not? Its based on coding data. What hospital is going to code for something they KNOW they can’t get paid for.

    Anyway, the non doctors on this site who postulate the completely INAPT analogy about hitting someone with a car should know that it is often a catch 22. Example: A bed bound patient admitted with pneumonia cannot get out of bed. Well diapers aren’t hygenic, but if you place a Foley, then there’s arisk of infection. So is a catheter related infection an “error”? I don’t think so. It solved the other problem of having the patient stew in a diaper filled with urine and possible skin ulcers, which would apparently be considered ANOTHER error.

    So many examples are proof that it’s an unfair and bogus construct. If they were really concerned with lowering complications, they would have monitoring in hospitals and pay for systems that would ensure lower rates of such things. Intsead of just screwing already-underfunded hospitals.