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.
