Wednesday, January 16, 2008
What is a "never" event?
Theoretically they are things that should never happen in the hospital. But there is some gray area.
Posted by Kevin |
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The reasons for denial of payment is merely being expanded, but not necessarily for things within the control of the physician, nurses, and hospital.
Not paying for surgery on the wrong body part of course would be expected; it was not consented to by the patient, and did not have pre-approval from the insurer.
But they are trying to slip in some things that despite good care can still happen, and indeed, like hypoglycemia are known complications of appropriate care. In all studies of of tight glycemic control, which improves patient outcomes, the treatment group experienced a higher rate of hypoglycemic injury. This is in the tightest of practice under clinical trials, suggesting that even supranormal levels of vigilance cannot reduce all hypoglycemia complications. But in the end, patients are better off with the attempt for tight glycemic control, because the benefits outweigh the risks; even counting the complications against the tight control group, they did better than if only minimal glycemic control (with low rates of hypoglycemia) was used.
But now with the 'risk' from hypoglycemia increased beyond the human cost, care will tend toward lesser control, with more complications.
Incentive systems always work; just be careful what you incentivise.
Not paying for surgery on the wrong body part of course would be expected; it was not consented to by the patient, and did not have pre-approval from the insurer.
But they are trying to slip in some things that despite good care can still happen, and indeed, like hypoglycemia are known complications of appropriate care. In all studies of of tight glycemic control, which improves patient outcomes, the treatment group experienced a higher rate of hypoglycemic injury. This is in the tightest of practice under clinical trials, suggesting that even supranormal levels of vigilance cannot reduce all hypoglycemia complications. But in the end, patients are better off with the attempt for tight glycemic control, because the benefits outweigh the risks; even counting the complications against the tight control group, they did better than if only minimal glycemic control (with low rates of hypoglycemia) was used.
But now with the 'risk' from hypoglycemia increased beyond the human cost, care will tend toward lesser control, with more complications.
Incentive systems always work; just be careful what you incentivise.
The listed complications are not always preventable, and the policy will result in some unfair denial of payments, but everyday there is a great deal of unfair billing as it is unfair to bill for sloppy medical care at the same rate as good medical care. A great deal of money is spent paying people more money for bad care than for good care and some small attempt to make a dent in that is laudatory.
As it is, sloppy care is more profitable. It takes less time and resources to not take care of the patient, and then you get to bill more because they get sicker and stay longer.
I could add several other things that ought not be paid for that I have seen on chart reviews:
DT's emerging in and complicating the stay of patients who presented with clear alcoholism and intoxicated with levels of 300 who are put on the surgical service to treament of the their trauma with no prophylaxis, thaimine, or detox checks.
Severe complications due to drug toxicity when the lab isn't ordered timely, and then isn't attended to when it is finally reported.
And many other examples of a simple failure to attend to patients.
Time to stop blaming everyone else and get our house together. Perhaps greed will do what professionalism will not.
As it is, sloppy care is more profitable. It takes less time and resources to not take care of the patient, and then you get to bill more because they get sicker and stay longer.
I could add several other things that ought not be paid for that I have seen on chart reviews:
DT's emerging in and complicating the stay of patients who presented with clear alcoholism and intoxicated with levels of 300 who are put on the surgical service to treament of the their trauma with no prophylaxis, thaimine, or detox checks.
Severe complications due to drug toxicity when the lab isn't ordered timely, and then isn't attended to when it is finally reported.
And many other examples of a simple failure to attend to patients.
Time to stop blaming everyone else and get our house together. Perhaps greed will do what professionalism will not.
# posted by 
: 7:42 PM
: 7:42 PM
The lawsuit has all the features of a product. It is inherently harmful in its ordinary use. I suggest strict liability apply to all weak cases.
Appellate decision are based on judge errors in the law, not on errors of facts. All reversed decisions are "never events." The judge should not get paid for any reversed decision.
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Appellate decision are based on judge errors in the law, not on errors of facts. All reversed decisions are "never events." The judge should not get paid for any reversed decision.
