Comments on: The problems of not paying for Medicare errors http://www.kevinmd.com/blog/2007/08/problems-of-not-paying-for-medicare.html Tue, 14 Feb 2012 22:04:00 +0000 hourly 1 By: Mikehttp://www.kevinmd.com/blog/2007/08/problems-of-not-paying-for-medicare.html#comment-79522 Mike Sat, 25 Aug 2007 01:43:00 +0000 http://clients.emmense.com/kevinmd/2007/08/the-problems-of-not-paying-for-medicare-errors.html#comment-79522 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.<br/><br/>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.<br/><br/>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. 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.

]]> By: Anonymoushttp://www.kevinmd.com/blog/2007/08/problems-of-not-paying-for-medicare.html#comment-79514 Anonymous Fri, 24 Aug 2007 11:14:00 +0000 http://clients.emmense.com/kevinmd/2007/08/the-problems-of-not-paying-for-medicare-errors.html#comment-79514 "What most studies show is that if you don't want to be held financially accountable, communication with your patients is the key."<br/><br/>Just thought that deserved to be repeated.<br/>And if your Risk Management people object -- ditch them. After all, they work for YOU. “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.

]]> By: Anonymoushttp://www.kevinmd.com/blog/2007/08/problems-of-not-paying-for-medicare.html#comment-79512 Anonymous Fri, 24 Aug 2007 10:32:00 +0000 http://clients.emmense.com/kevinmd/2007/08/the-problems-of-not-paying-for-medicare-errors.html#comment-79512 <i>a demented, bed bound, person developing a pressure sore and a superimposed MRSA infection, does not fall into that category.</i><br/><br/>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?<br/><br/>Could they not be getting custodial care, and treating the bedsore in a nursing facility that would have some degree of normalcy for them? <br/><br/>As a society maybe we have to come to grips with the notion that in some circumstances less is better. 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.

]]> By: Anonymoushttp://www.kevinmd.com/blog/2007/08/problems-of-not-paying-for-medicare.html#comment-79510 Anonymous Fri, 24 Aug 2007 06:47:00 +0000 http://clients.emmense.com/kevinmd/2007/08/the-problems-of-not-paying-for-medicare-errors.html#comment-79510 "...just that you were injured on the job."<br/><br/>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. “…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.

]]> By: Anonymoushttp://www.kevinmd.com/blog/2007/08/problems-of-not-paying-for-medicare.html#comment-79508 Anonymous Fri, 24 Aug 2007 06:32:00 +0000 http://clients.emmense.com/kevinmd/2007/08/the-problems-of-not-paying-for-medicare-errors.html#comment-79508 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. 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.

]]> By: Anonymoushttp://www.kevinmd.com/blog/2007/08/problems-of-not-paying-for-medicare.html#comment-79507 Anonymous Fri, 24 Aug 2007 05:14:00 +0000 http://clients.emmense.com/kevinmd/2007/08/the-problems-of-not-paying-for-medicare-errors.html#comment-79507 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. <br/><br/>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. 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.

]]> By: Anonymoushttp://www.kevinmd.com/blog/2007/08/problems-of-not-paying-for-medicare.html#comment-79506 Anonymous Fri, 24 Aug 2007 05:05:00 +0000 http://clients.emmense.com/kevinmd/2007/08/the-problems-of-not-paying-for-medicare-errors.html#comment-79506 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".<br/><br/>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. 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.

]]> By: Anonymoushttp://www.kevinmd.com/blog/2007/08/problems-of-not-paying-for-medicare.html#comment-79501 Anonymous Fri, 24 Aug 2007 04:34:00 +0000 http://clients.emmense.com/kevinmd/2007/08/the-problems-of-not-paying-for-medicare-errors.html#comment-79501 "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."<br/><br/>What a stupid thing to say. And actually, lawyers are held to a standard of care also, and don't have the locality rule.<br/><br/>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? “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?

]]> By: Anonymoushttp://www.kevinmd.com/blog/2007/08/problems-of-not-paying-for-medicare.html#comment-79497 Anonymous Fri, 24 Aug 2007 03:16:00 +0000 http://clients.emmense.com/kevinmd/2007/08/the-problems-of-not-paying-for-medicare-errors.html#comment-79497 There seems to be the equation of poor result with error. <br/>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. <br/>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.<br/><br/>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). <br/><br/>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. 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.

]]> By: Anonymoushttp://www.kevinmd.com/blog/2007/08/problems-of-not-paying-for-medicare.html#comment-79495 Anonymous Fri, 24 Aug 2007 02:50:00 +0000 http://clients.emmense.com/kevinmd/2007/08/the-problems-of-not-paying-for-medicare-errors.html#comment-79495 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. 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.

]]>