When it comes to preventing Medicare’s so-called “never” events, sometimes the solution is worse than the problem.
I wrote about it last year in the USA Today, saying, “While withholding payment for inexcusable medical mistakes is a sensible concept, Medicare’s decision to penalize hospitals for more nuanced complications raises the bar too high. You cannot regulate perfection.”
And preventing patient falls has nuance written all over it.
The New England Journal of Medicine recently wrote as much, noting that as much as we’d like to prevent falls (via Dr. RW), there is no reliable evidence showing that it can be done.
Worse, unintended consequences will rear its ugly head:
If hospitals are scrutinized for the occurrence of falls, the natural tendency will be to focus on such events even at the expense of competing (and perhaps more important) outcomes. Unintended consequences are likely to include a decrease in mobility and a resurgence in the use of physical restraints in a misguided effort to prevent fall-related injuries.
And, of course, unscrupulous companies are trying to profit off renewed focus on fall prevention, selling all sorts of devices designed to inhibit movement, much of it to the patient’s detriment.
So, while falls in the hospital should not be ignored, penalizing medical centers for them “may be harmful to the very patients it is intended to protect.”
Indeed.
Related posts:
- Do canes and walkers prevent falls in the elderly?
- USA Today op-ed: Medicare’s never events and the unintended consequences affecting patient care
- The unintended consequences of P4P
- Unintended consequences of mandates
- Pay for performance unintended consequences
- Hospitals lose money by preventing patient re-admissions
- The unintended consequences of electronic records
{ 10 comments }
It’s the law of unintended consequences: push in on the balloon here, it bulges out there. The focus on never events not only has this result, but the Medicare rule as currently structured saves only $21 million/year (CMS’s own figures; see http://bit.ly/z8JFO) which is bupkes (a technical term).
This is one of the many reasons that patches to the FFS system won’t work well, and that a move to a global payment system will work better.
How about patients sue when they aren’t cared for properly, and are dropped after mishandling, or left with bed rails down while they are at high risk of being unable to stop a fall?
That seems incentive enough, the threat of financial loss for negligence, to adopt safe practices.
Shocking solution, this “individual circumstance” evaluation.
This reminds me (in a round-about way) of a tweet I saw recently from Houston’s Memorial Hermann Hospital (@houstonhospital) telling people to “Avoid this unsafe equipment at the playground: animal swings, trampolines, monkey bars, swinging ropes, exercise rings and trapeze bars.” Sure, but then wonder why kids are more & more inactive, and why they seem to find the playground boring…
http://twitter.com/houstonhospital/status/2407006217
The biggest one I see being a problem is catheter related infections. Why put a foley in anymore, if that goes down. People are going to have to like lying in their own piss.
SarahW, A patient shouldn’t be able to sue for the bed rails being left down, we are required by law to leave them down now because putting them up is a form of “restraint” and therefore illegal. Damned if you do, damned if you don’t.
Has anyone thought about just focusing on what is best for the health of the patients, rather than just chasing the money around like a Basset Hound? It always bothers me when I see “hospitals will do x instead” in order to ensure they are not penalized, even if it harms the patient just as much as “y” did. How about just doing what’s right for the patient? If a hospital’s response is to put a patient in physical restraints that are unwarranted, then that hospital is being greedy, unethical and very non-patient-focused. Maybe someday, hospital administrators will just choose to do the right things for the right reasons. It does not appear that today is that day.
And, Kevin, rather than just outright condemning the idea of penalizing hospitals for something, like falls, that should not happen, it would be nice if you would offer an alternative rather than just advocating for the status quo. The status quo hasn’t and doesn’t work. That is why cutting-edge thinkers are pushing for change.
I like when we routinely get yelled at for having the highest rate of blood stream infections. The BMTU? Shocker.
Kevin:
How timely…I was just talking about this issue with my old boss.
They don’t count patient stupidity (or carelessness) either when they lump all falls together, even when the patient is AOx3 and readily admits, “I just did it myself and never asked for help.”
Kevin –
This issue hits a nerve. I can’t tell you the countless hours of manpower and resources that our little rural access hospital is spending on this. The piles of paperwork are ridiculous. Our nurses are too busy learning what constitutes fall risk and how to avoid unintended “restraint” that they don’t have time to review (or even learn in the first place) basic life saving skills as such as those taught in PALS and ACLS. When did we step away from patient care and become a business of paper?
I saw some of the unintended consequences of this policy when my father was hospitalized recently. They either tied him down or had a ‘don’t get out of bed’ nazi with him at all times. They would let him leave without being able to walk, but pt was only able to visit him once in 10 days so that he could walk. As a result he was damn near unable to make it up the 2 steps into the house when he got home. I realize that none of this is the hospital’s fault, but really, fall at the hospital horrible, fall at home, at least it’s not the hospital’s fault. The consequences to patients on this one will only magnify over time.
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