The big news this week is that Medicare is going to stop paying for medical mistakes. That was the headline put out in every paper around the country. Sounds ridiculous, right? Why would the government pay for mistakes (Iraq, FEMA, etc.) in the first place? Well, the answer is not that simple. According to the administration, Medicare will no longer pay hospitals for the costs of treating certain “conditions that could reasonably have been prevented.” This includes bedsores, injuries caused by falls, and infections resulting from the prolonged use of catheters in blood vessels or the bladder. They also won’t pay for the treatment of “serious preventable events” like leaving a sponge or other object in a patient during surgery and providing a patient with incompatible blood or blood products.
Intuitively, this sounds pretty smart. But is it? Obviously, the intention to stop neglect is a good one. There are, however, times when bad things do happen and it is not anyone’s fault. The future fallout from this will be very interesting. This means more administrative oversight to double check everything on each patient in the hospital which means more, well, administrators. That can’t be a good thing.
I am fully aware that we can always do better. But a UTI from a catheter? Trust me, there is going to be a lot of fudging in future documentation. No doc is going to want to be dinged for making these “mistakes”.
Yes, it is wrong to leave a sponge in someone’s peritoneal cavity. A bed sore, however, in a quadriplegic 400 pound man is going to be tough to stop. Did that sore start before they came in? I guarantee that there will be more “diagrams” on the chart highlighting anything close to looking like a sore. Doctors will have to get some extra blood and urine tests before the patient gets admitted just in case something shows up later. This won’t cost too much; now will it?
The bottom line is that while I agree on the intention, I am very suspect of the initiative. There are now going to be infection police roaming the hallways like elementary school hall monitors looking for bathroom passes. There will also be accident teams that will be skilled in the art of documentation manipulation that will allow the hospital to show that they were not at fault. The cost of these new jobs will, in my estimation, equal what it was before they were created. And don’t forget the new MRSA wings that keep these patients in total isolation from everyone else. That has got to cost a pretty penny as well. Oh well, I guess the hospital will just have to raise its rates somewhere else to make up for it. It’s not like they are going to cut their CEO’s salary.
Lastly, hospitals are going to have to report this data on how good they are doing. Ranking systems will be constructed and nice new awards will have to be created so the “cleanest” hospitals will enable their marketing team to brag to the media. Alabash County Hospital winning the Golden Catheter Award is good PR and a great story for the local paper. This is going to be fun and in the long run, a pain in the ass.
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