The following op-ed was published on January 14th, 2009 in the USA Today.
Every patient’s worst nightmare is going to the hospital for a procedure only to have a surgical instrument left in his body, the wrong limb or organ operated on or, worse, dying from a medical mistake. These types of mistakes should never happen.
So when Medicare recently instituted a plan to deny hospital payments for catastrophic medical errors or “never events” its initiative received widespread acclaim.
“When you enter a hospital,” says Herb Kuhn, deputy administrator of the Centers for Medicare and Medicaid Services, “you don’t want to leave with something else. Let’s get it right the first time.”
Real physician voices, twice a week
Free, and one click to unsubscribe.
Medical errors, though rare, contribute to nearly 100,000 deaths a year in the U.S., according to the Institute of Medicine. These mistakes are ultimately paid for twice “” once for the error and again for the subsequent treatment to fix it. The result is almost $10 billion in annual excess charges.
Preventive action
Medicare deserves to be lauded for modifying its payment system to promote healthy outcomes over the quantity of care and, in the process, reducing unnecessary excess charges for errors that should never happen.
Where Medicare goes wrong, however, is by extending the no-pay rules to include “reasonably preventable” complications. These currently include patient falls and hospital-acquired infections. Temporary changes in mental status, known as delirium, also will be added this year.
Despite impeccable care, some hospital complications cannot be prevented. For example:
* No studies exist that show how infections can be cut to zero.
* The government acknowledges that there are few effective guidelines to reliably halt the onset of delirium.
* The AARP reports that one in three seniors older than 65 falls each year.
Penalizing hospitals for events that cannot be prevented is counterproductive and leads to unintended consequences, including driving up the cost of care by exposing patients to more testing, thereby decreasing access to medical care.
Who is at fault?
When a hospitalized patient develops an infection, for instance, it can be difficult to determine whether the fault lies with the medical staff or with a predisposed condition. This is a crucial distinction because Medicare will punish the former scenario but pay in the latter.
Hospitals might be motivated to order tests, without clear medical symptoms, to show that any infection caught from within its walls was already pre-existing.
The American Medical Association shares this concern, saying that the aggressive expansion of no-pay events can “drive up costs by requiring more tests upon admission.”
Furthermore, some institutions could decide not to admit or perform elective procedures on high-risk patients, particularly the elderly, out of fear of being denied payment for complications it cannot prevent.
Robert Wachter, professor of medicine at the University of California-San Francisco and an authority on hospital medicine and patient safety, cautions that the rapid expansion of the no-pay idea looks like a “cost-cutting effort clothed in the garb of patient safety” that is “nowhere near ready for prime time.”
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.
Kevin Pho, MD, is a practicing, board-certified internal medicine physician and the founder and editor of KevinMD, which he built from scratch in 2004 to give clinicians and patients a place to be heard. Over two decades, it has become one of the most recognizable physician-led publications in health care, drawing more than 7 million annual page views and over 500,000 followers across social media. He still sees patients in primary care in Nashua, New Hampshire, the practice he says keeps the platform honest.
He is the host of The Podcast by KevinMD, a daily, 15-minute show that has surpassed 2,000 episodes and 2.6 million IAB-certified downloads, featuring physicians, patients, caregivers, founders, and health care leaders in conversation about what they actually see and do. He is also a national media commentator and the coauthor of Establishing, Managing, and Protecting Your Online Reputation: A Social Media Guide for Physicians and Medical Practices.
An acclaimed keynote speaker, Kevin speaks nationwide to clinicians and non-clinicians on health care, digital media, physician leadership, and burnout. His signature keynote, “Connect and be heard: Make a difference in health care with social media,” traces his social media journey since 2004 and inspires audiences to strengthen the doctor-patient relationship, make their voices heard in health reform, and turn the tide against clinician burnout. He is the founder of Physician Speaking by KevinMD, a physician-run speakers bureau, and is available for speaking opportunities.
Kevin earned his medical degree from Boston University School of Medicine and completed his internal medicine residency at Boston University Medical Center. The New York Times called KevinMD “a highly-coveted publishing place for doctors and patients,” and Forbes called it a “must-read health blog.” He is an inductee of the Healthcare Internet Hall of Fame, a recipient of the American Medical Writers Association McGovern Award, and a New Hampshire Magazine Top Doctor.
