In no other business that I know of, can you turn a profit when you sell a defective product or service. If the television set you purchased at your local electronics store doesn’t work when you get home, you take it back to the store and get a refund or exchange. When the mechanic doesn’t repair the brakes on your car properly, you don’t pay him until they’re fixed. If the bread you buy at the grocery store is moldy you take it back and get fresh loaf.
Back what if you can’t take it back? What if there are no exchanges? Suppose you go to the hospital and they cut off the wrong limb or operate on the wrong body part. You can’t take that back. You can’t get an exchange. What if not only did the hospital provided inferior care but charged you for it as well? It happens all the time at hospitals all over the United States.
An article in the Journal of American Medical Association focuses on a common but mostly preventable medical error, urinary tract infections associated with the use of a catheter. In a perverse twist, the hospitals are actually rewarded for bad care.
Urinary catheters are the most commonly used medical devices in hospitals, and account for approximately one million infections annually. That’s 40 percent of all hospital-acquired infections. A urinary tract infection can add a day to a hospital stay; and it can lead to a more serious infection and even death.
According to the article, Medicare would pay a Colorado hospital, $5,436.66 for the care of a heart attack patient who recovered with no complications. But if there were complications due to a urinary tract infection related to use of a catheter, the hospital is paid $6,721.44. If there were more serious complications due to catheter, the hospital collected $8,905.43. So, it seems it’s in the best interest of the hospital that patients receive inadequate care. Hospital-acquired urinary tract infections are largely preventable but the cost the health care system more than $400 million every year. The reimbursement system “tolerates and even financially rewards poor performance by hospitals that fail to prevent hospital-acquired complications,” write the report’s authors, Dr. Heidi Wald and Dr. Andrew Kramer, health care policy researchers at the University of Colorado at Denver.
Most infections occur when a catheter is left in too long. The risk of infection rises dramatically 48 hours after insertion. Patients usually don’t need a catheter for nearly that long, but when nurses and other hospital staff are overworked, or when record-keeping is lax, catheters may not be removed soon enough.
Eleven states have adopted a policy of waiving the fee for the worst mistakes, which have been dubbed “never events”, meaning they should never happen at all. The NQF (National Quality Forum) has identified 28 never events that include surgery on the wrong part, surgery on the wrong patient, wrong surgery performed on a patient, items being left behind in a patient and a baby sent home with the wrong mother.
In an effort to hold hospitals accountable, Medicare changed how it will reimburse the costs associated with eight largely preventable injuries or “never events”. Now, the agency will not pay hospitals when doctors leave an object in a patient during surgery, use the wrong blood or introduce an air embolism while treating a patient. They will no longer compensate hospitals for infections that develop due to the use of vascular catheters, pressure ulcers, surgical site infections after coronary bypass surgery and other hospital-acquired injuries, such as fractures or burns that occur due to inadequate care. Some private insurers are considering adopting similar rules.
“All too often, clinicians, hospitals, and payers conclude that some harms are part of the price of doing business. But in many cases they are not,” write Dr. Wald and Dr. Kramer. “When properly designed, financial incentives should provide rewards for desired clinical outcomes, not hospital-acquired harms.'”
Not rewarding hospitals for inferior care? All I can say is, it’s about time!