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What The Hell Took So Long?

There's a story in today's Boston Globe that really set off my "well, duh!" muscles -- and not in the usual way.

It seems that hospitals are, by and large, not going to charge people for their screwups.

There is a category of medical mishaps that are called "never events" -- events that should never happen to patients. Stuff like instruments being left inside during surgery, bedsores, certain types of falls, and whatnot -- the kinds of things that can only come about from gross negligence on the part of hospitals.

The surprising thing about this is not that it's being done, but that it hasn't been done before.

I think this is a good thing. It'll encourage hospitals to watch themselves more carefully, 'fess up when they do blow it, and give people the satisfaction of knowing quickly when they have been the victims of a screwup.

Plus, it ought to help keep the John Edwards of the world away from the situations, and that can only be a good thing.


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Comments (8)

Listen Docs pee and moan ab... (Below threshold)
Dick Butts:

Listen Docs pee and moan about the cost of their malpractice insurance and then they refuse - outright refuse and fight not to have to - to police their own.

For years many have called out for a list of doctors who are sanctioned by their boards to be published. The theory being bad docs will be avoided by the public, and claims will go down (the bad docs are the big problem - just like bad drivers - they cause a bunch of the "accidents"). Doctors say no to such a published record.

Bedsores should be qualifie... (Below threshold)
Don:

Bedsores should be qualified like falls, as in "certain types of bedsores" should never happen. In the very elderly organs begin to fail, the skin is an organ, sometimes the skin is one of the first organs to fail. Patients can develop something akin to onion skin where bedsores simply cannot be prevented. Unfortunately, they are some of the most horrible wounds...think open wound that you can put a whole fist or two into. Combine that visual with a expert witness whore who spouts off that all bedsores are preventable and you have a trial lawyer's dream case. The fact is, not all bedsores are preventable.

I call BS on this. When I ... (Below threshold)
Mycroft:

I call BS on this. When I was in the hospital in 1994, they screwed up in the blood they delivered to me. I got charged for the full pint, even though only half of it went into me (The other half was on the floor, thru the incompetince of the two nurses).

Unless the current system i... (Below threshold)
epador:

Unless the current system is changed dramatically, admitting you screwed up opens you up to more liability, which inhibits this approach.

Malpractice insurance can be rather obscene in costs, but it is simply a reflection of the system of tort management of medical errors.

Lastly, as noted in post #2, you can have "never events" - which also include "hospital acquired infections" - that are inevitable for certain sick and frail patients. If the hospital thinks that a certain patient is likely to encounter a "never event" that they then will never be paid for the entire hospitalization, whaddya think the likelyhood is the hospital will refuse the patient, or claim they are "too complicated" and send them upstream? I think this could be a major unintended consequence of mandating this. Also, the insurance companies, Medicare included, just love to exploit any reason they can find not to pay.

I see this as a boondoggle, not an advance.

Jay, I agree with most of w... (Below threshold)
Faber:

Jay, I agree with most of what you say, but you're missing the boat on this. As others have said, the problem is that so much of what's going to be defined as "never events" are actually common byproducts or unavoidable complications of chronic disease.

This isn't about forcing doctors and hospitals to police themselves, or preventing surgical instruments from being left inside patients after surgery (but what good press that is, huh?). This is about more government control over health care. "He who controls the purse strings makes the rules" - as when Medicare stops paying for some of these conditions, here's the result:

More inpatient care in hospitals not covered by Medicare and insurance --> More hospitals in financial trouble --> Cost cutting by these hospitals as they try to stay afloat (cuts in RN staff, ancillary services, oversight, etc) --> Decreased quality of care --> More complications, sickness, death in the hospital --> More cries for governmental control --> Hello, Hillarycare!

One of the biggest problems... (Below threshold)
Robin Goodfellow:

One of the biggest problems in medical malpractice today is how horribly punitive it is. The idea, no doubt helped along by lawyers and the potential financial gain involved, is that problems in medicine are always an individual's or group's fault. In reality even when individuals are at fault much of the reason for making mistakes can be traced back to bad procedures, poorly designed equipment, etc. The system that we have now only encourages the removal of sloppy and imperfect individuals, it does very little to improve underlying problems in poorly designed systems, procedures, or equipment.

Epador is spot on with his ... (Below threshold)
Imhotep:

Epador is spot on with his analysis.
But what makes you think this non-payment for services rendered is 'unintended'.

You can bet they never intended to pay for services.

Bedsores and infections are completely unavoidable in some instances. This will only result in non-coding or re-coding the disease entity.

If I get the ICD-9 codes that will trigger a nonpayment from Medicare or Insurance, guess which codes I will never submit to billing!

Duh.

Also, not billing for a pro... (Below threshold)
Imhotep:

Also, not billing for a procedure is illegal and equal to admitting fault.

For instance, if I perform surgery and all goes well technically, but the patient dies 3 days later from a heart attack or pulmonary embolism and I don't charge for the surgery, a jury will easily see that as admitting fault or cause.




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