Will physician and hospital penalties improve patient care?

Originally published in HCPLive.com

by Alan Berkenwald, MD

In 1904, the Scottish author Sir James Matthew Barrie sent Peter Pan off to Never-Never Land to escape growing up and to enjoy many-many adventures. As children, we all hoped it really existed. In truth, many of us fantasized, one day, to make the trip ourselves.

Well, good news for physicians – that day has arrived!

Will physician and hospital penalties improve patient care? The Centers for Medicare and Medicaid Services, in a noble effort to improve patient safety – and reduce expenses – has outlawed the occurrence of hospital based “never events,” which are defined as preventable illnesses or complications that occur in hospitals.

Thus, with a stroke of the legislative pen, patients will no longer suffer falls, catheter associated UTI’s, surgical site infections, DVTs or pulmonary embolism among other things. Should such an event occur there will be repercussions, so far limited to denying reimbursements for these events, and some elements of data collection and full disclosure on patient safety.

In economics, this is called the “Rotten Apple Theory” – nothing is wrong with the system, it’s just a handful of rotten apple physicians that prevents our having an affordable health care system. If we find those bad physicians and punish them, all our health care system’s problems will go away.

Thus, we have arrived at Never-Never Land. And not a moment too soon. Forget statistics, forget the natural course of a disease, forget all about complications that do occur despite our best efforts. Henceforth, at institutions great and small, from Man’s Greatest Hospital to the smallest community clinic, there will be no pulmonary embolisms or post op infections, no uncontrolled diabetes, no never events.

Why didn’t we think of this sooner?

These complications, and more, will soon go the way of smallpox, another disease that disappeared. Now, Medicare will use Adam Smith’s invisible hand and the power of economic self interest to improve healthcare safety.

This presupposes physicians and hospitals are only in it for the money. Adam Smith proved long ago that altering compensation alters behavior. However, I guess I missed the study that proved paying physicians less decreased errors and misjudgments. Since cutting Wall Street salaries is now the cure for banking malfeasance, I guess cutting physician and hospital reimbursements will do the same.

The writer Sholom Aleichem, at the close of the 19th century, told humorous stories of the Wise Men of Chelm, the elder leaders of a small village in the Pale of Russia. As one holiday approached there was no sour cream for the traditional blintzes. So, the Wise Men of Chelm decreed that henceforth, all well water would be called sour cream, and all sour cream would be called well water. And so, the holiday was saved.

In Never-Never Land physicians will not make mistakes, our health care system will not run a deficit, and I can fly.

Alan Berkenwald is an internist who blogs at In the Name of Medicine.

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  • gerridoc

    Well said!!

  • jsmith

    Obviously, this administrative juggernaut will fail miserably. In the meantime, however, it is something for the government to do.
    Perhaps it has to be tried before the hard decisions can be made to get to real solutions, like making sure this country has enough primary care docs, and making sure their practices are financially and clinically viable.

  • TrenchDoc

    The next logical step is for these events to trigger malpractice action. After all if these events should never occur when they do occur it must be someone’s fault. Guess who that will be. The hospitalists will get hammered with this. Surgeons are already turning over the post op care to hospitalists and now they will be transferring the legal duties as well. The only safe place to practice will be to work for the government since everone knows how difficult it is to sue the government.

  • BladeDoc

    I don’t know if everybody is just playing along or are really missing the point: THEY DON’T CARE whether the complication occurs or not as long as the government doesn’t have to pay for it.

  • ninguem

    Herodotus Travels. His observation in Babylonia. Might this be the effect of the Code of Hammurabi?

    “They have no physicians, but when a man is ill, they lay him in the public square, and the passers-by come up to him, and if they have ever had his disease themselves or have known any one who has suffered from it, they give him advice, recommending him to do whatever they found good in their own case, or in the case known to them; and no one is allowed to pass the sick man in silence without asking him what his ailment is.”

  • Greg

    The most silly “never event” is delirium. It is neurologically IMPOSSIBLE to prevent all cases of delirium, especially in a setting where lifesaving medications including pain meds are well known to trigger delirium. I think patients will suffer the most as doctors will refuse to give pain medications for fear of causing delirium, which would lead to them having a “never-event.”

    If pain meds can cause delirium, and delirium is a “never-event,” then the simple solution is to not give pain meds. Ever.

  • ninguem

    And delirium may be a terminal event. The delirium is because the old person is about to die.

  • jsmith

    On the positive side of things, maybe this will make hospitalist work so miserable that the hospitalists will go back to internal med or family med, thus improving the supply of outpatient docs. Perhaps this is the government’s evil yet brilliant plan. Or maybe not.

  • jenga

    I think catheter associated UTIs as never event is pretty comical. If I was an administrator, the foley catheters would disappear on the date of enactment and nothing but straight caths or the alternative of lying in your own piss. Just let the family know, it is courtesy of the federal government. Tell them they don’t pay for foley’s anymore, but urine is sterile so it won’t hurt anything.
    P.S.
    All of you ultrasound techs, You’re fired. No DVTs in my hospital.

  • Caroline Andrews

    Of course it’s a good thing to try to reduce the incidence of these events. To make never-events never happen, though, is impossible. I fear that, in some cases, this will lead to under-treatment of such events.

    Perhaps those running the country should not be paid this year. They’ve certainly been making a mess of things.

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