Hospitals Will Have to Pay for Mistakes

Vanessa Fuhrmans of the Wall Street Journal reports that insurance companies are probably going to stop paying for medical treatments made necessary by “never-events,” (list from the National Quality Forum) those major screw-ups you pray a hospital never commits.  Examples include leaving a sponge in a surgery patient, amputating the wrong limb, transfusing the wrong blood type, etc.  Participating insurers are following Medicare’s lead, and not allowing themselves, or patients to be billed for errors that should, under no circumstances, occur.  Some of these insurers are WellPoint, Aetna, Cigna, UnitedHealthcare, and Humana.

The purpose is to incent hospitals to prevent these mistakes in the first place, which cost billions a year to insurers, hospitals and patients alike.  Laissezfairehealthcare is in favor of this.  Eventually more preventable errors that aren’t necessarily never-events, will become never-events as hospitals become safer and less accident-prone.  While hospitals could spend money trying to skirt around these new restrictions, or attempt to pass the cost through to the insurers and patients another way, many will discover simple updates in policies and procedures, personel changes, or technological investments will more than pay for themselves in improved patient outcomes.

Smart hospital administrators are already seeing the light: “[t]o lower its rate of infection…Pitt County Memorial Hospital in Greenville, N.C., in February expanded its screening for methicillin-resistant staph infections to all patients coming into the hospital. By identifying and isolating those with the strain early, it lowered the number of MRSA pneumonia cases related to ventilator use by 67% and MRSA urinary-tract infections by 60% within eight months. In all, the expanded screening has cost nearly $1 million, $800,000 picked up by private and public insurers.  Steve Lawler, the hospital’s president, says it has more than recouped its $200,000 investment. Moreover, spending the money to make the hospital safer is a “better return on investment…than some billboard campaign,” he says.”

For another viewpoint – visit to the Verden Group’s blog.

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U.S. vs. Canada: Physician Wait Times

In my recent post “Let’s Pick on Canada Now,” I discussed the physician shortage in Canada and how it has affected wait times for specialist treatment — which edged up over 18 weeks last year.

Unfortunately (or fortunately for this blog), I was able to compare a personal experience in the U.S. with the statistics cited by the Frasier Institute for Canada.  After a couple of months of somewhat debilitating respiratory symptoms and general sickliness, I decided enough was enough and petitioned my primary care physician to see a specialist…during the second week of December – which is arguably the hardest time to get non-emergency medical treatment.  I have the cheapest-option employer-based HMO insurance coverage through United Healthcare.

In less than three weeks, I saw two specialists, a cardiologist and a pulmonologist; had a barrage of tests including x-rays, blood tests, pulmonary function tests, and an EKG; and received diagnosis and treatments.  It probably would’ve been two weeks or less any other time of year.  Granted, I didn’t need invasive treatment, surgery, etc…but I think the comparison still stands — Canada’s average time between referral and treatment (non-surgical included), is over 18 weeks.

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