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Patient Safety and the Purse Strings

Posted on | January 28, 2008 | No Comments

Will medical errors stop because hospitals (and doctors) don’t get paid?

The State of Pennsylvania just announced that it would no longer make Medicaid payments to hospitals for serious, preventable medical errors, following the path laid out by the Federal government’s Medicare no-pay policy announced last August. Of course, both programs mean they will no longer pay for repairing the results of the injury – for example, removing a sponge left in a surgical patient or resuscitating a patient after a severe reaction to a drug, either of which may keep the patient in the hospital for days or weeks.

The argument that the Feds put forth is simple: In the United States, the costs of health care are the highest in the developed world, and the quality is mediocre. “We must reduce costs and improve quality,” they say. And money talks. If the policy works in hospitals – and it’s too early to know – the policy may extend to care in ambulatory care settings. Serious errors in the doctors’ office practice can be detected only when the patient winds up in the hospital or with a consultant who identifies a wrong diagnosis or treatment.

The policy might work in hospitals by improving systems for quality control in the OR and at the nurses’ station. But given the state of evidence-based medical care, which is based on truly solid evidence in only about 20-25% of diagnoses, we wonder whether the government is pushing care in the wrong direction: toward more litigation on the part of patients, and toward more fear and caution on the part of doctors. Imagine your doctor saying, “I’m sorry. I’m not sure enough of a diagnosis to treat you. I’ll send you to another doctor because I might not be paid for your care –0 and worse, I might be sued!”

It doesn’t sound plausible, but negative change might occur in more subtle ways. What do you think? Are there more sensible ways to control costs and improve quality? I have some ideas, but I’d like to hear yours first.

(Lewis A. Miller is corporate editorial director of Dowden Health Media and co-founder and principal of WentzMiller & Associates, a global consulting firm. He can be reached at lew@wentzmiller.org. Opinions expressed by Health Commentary guest bloggers do not necessarily represent the views of Health Commentary.)

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