Re: Medicare Won't Pay for Medical Errors ... NY Times October 1, 2008

[Guest guest]

It's about time....my husband and I have been saying this for years.

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> http://www.nytimes.com/2008/10/01/us/01mistakes.html?_r=1 & hp & oref=slogin

> Medicare Won't Pay for Medical Errors

> By KEVIN SACK NY Times October 1, 2008

> ST. PAUL— If an auto mechanic accidentally breaks your windshield

> while trying to repair the engine, he would never get away with

billing you for

> fixing his mistake. On Wednesday, Medicare will start applying that

logic

> to American medicine on a broad scale when it stops paying hospitals

for the

> added cost of treating patients who are injured in their care.

> Medicare, which provides coverage for the

> elderly and disabled, has put 10 " reasonably preventable "

> conditions on its initial list, saying it will not pay when patients

receive

> incompatible blood transfusions, develop infections after certain

surgeries or

> must undergo a second operation to retrieve a sponge left behind

from the

> first. Serious bed sores, injuries from falls and urinary tract

infections

> caused by catheters are also on the list.

> Officials believe that the regulations

> could apply to several hundred thousand hospital stays of the 12.5

million

> covered annually by Medicare. The policy will also prevent hospitals

from

> billing patients directly for costs generated by medical errors.

> Because Medicare is the largest insurer

> in the country, its decision to refuse payment for preventable

conditions has

> already influenced others — public and private — to set similar

> criteria.

> Over the last year, four state Medicaid programs, including New York

's, have

> announced that they will not pay for as many as 28 " never events "

> (so called because they are never supposed to happen). So have some

of the

> country's largest commercial insurers, including WellPoint, Aetna ,

Cigna and Blue Cross Blue Shield plans in seven

> states.

> A number of state hospital associations,

> including here in Minnesota, have brokered voluntary

> agreements that members will not bill for medical errors. In April,

Maine became the first

> state to ban the practice statutorily.

> The Congressionally mandated Medicare

> measure is not projected to yield large savings — $21 million a year,

> compared with $110 billion spent on inpatient care in 2007. But it

carries

> great symbolism in the Bush administration's efforts to revamp the

> country's medical payment system, which has long been criticized as

> driving up costs through perverse incentives that reward the

quantity of care

> more than the promotion of health.

> The real money, many health economists

> believe, may come from reorienting the payment system to encourage

prevention

> and chronic disease management and to discourage unnecessary

procedures. The

> two major-party presidential candidates support such a realignment,

a rare

> point of consensus in a polarized health care debate.

> " This is a specific case of the

> larger pay-for-performance trend, the idea that you should pay more

for quality

> than lack of quality, or in this case pay less for defects, " said Dr.

> M. Berwick, president of the Institute for Healthcare

Improvement.

> " This whole trend is like a juggernaut, and it is not going to

> stop. "

> Pay-for-performance makes use of both the

> carrot and the stick. Medicare now grants bonuses to doctors and

hospitals that

> report quality measures. It is experimenting with rewarding

physicians who

> follow protocols for treating diabetes, coronary artery disease and

congestive

> heart failure. The Medicare Payment Advisory Commission, an arm of

Congress,

> recently recommended reducing payments to hospitals with high

readmission

> rates.

> Three years ago, HealthPartners, a

> Minnesota-based health maintenance organization, was first in the

country to

> refuse payment to hospitals for never events. Company officials said

the policy

> has yet to save much money. But at Regions Hospital in St. ,

which is owned by HealthPartners,

> the change has reinforced a new focus on reducing medical errors.

> " Historically, there's been

> some acceptance that these things happen, " said Brock D. , the

> hospital's president. " We've come to now accept that

> they're avoidable. And that's a sea change. "

> Some improvements have been

> technological, like an electronic prescribing system that has helped cut

> medication errors in half. Others are breathtaking in their

obviousness, like

> diligent hand-washing.

> Nurses have been trained to provide more

> information during shift changes about whether patients are prone to

falls.

> High-risk medications like heparin are now marked with pink labels

to ward

> against mix-ups.

> Shortly before A. Kehborn's

> recent ankle fusion surgery, her orthopedic surgeon, Dr. A.

Cole, checked

> records and asked her repeatedly whether he would be operating on

her left leg.

> He then took a sterile marker and signed his initials on her left ankle.

> As they prepared for surgery, technicians

> tallied sponges and blades so they could later be sure that none

were left

> behind. Before taking up his scalpel, Dr. Cole was reminded by the

> " Time-Out! " towel covering his surgical tray to call for a brief

> break.

> " We have here for a left

> ankle fuse, " he announced. " Does everybody agree? " After all

> in the room chimed their agreement, he made his incision.

> In pre-op, Ms. Kehborn, 48, said it had

> never occurred to her that patients might be charged for a medical

error.

> " It should be the hospital's

> and doctor's responsibility to step up to the plate and own up to their

> mistakes, " she said. " I'd be livid if we had to pay for

> it. "

> The patient safety movement picked up

> steam in this country in 1999, when the Institute of Medicine, a

prestigious

> advisory group, estimated that 44,000 to 98,000 Americans died each

year from

> preventable medical errors.

> In response, at least 20 states have

> passed laws requiring hospitals to report mistakes or preventable

infections

> publicly, according to the National Conference of State

Legislatures. The

> federal Centers for Medicare and Medicaid Services now requires

hospitals to

> report on 42 quality measures. Hospitals that do not fully report

may be docked

> up to 2 percent of their reimbursement.

> In 2002, the National Quality Forum, a

> standard-setting consortium for the health care industry, compiled a

list of 27

> largely preventable adverse events, a list that grew to 28 in 2006

with the

> addition of " artificial insemination with the wrong donor sperm or

> egg. " In 2003, Minnesota

> became the first state to require reporting of all errors on the

list, and last

> year the state's hospital association became the first to announce that

> its members would not bill for them.

> The number of never events in Minnesota reported to

> the state has been low — 106 in 2004-5, 154 in 2005-6 and 125 in 2006-7.

> The most frequent errors have been bed sores, retained objects and

wrong-site

> surgeries. Regions Hospital had six or seven

> reportable errors in each of those years, including one death, a

suicide.

> Because individual hospitals may report

> only a few serious errors a year, they have started collaborating to

look for

> common threads and propose solutions. Some of the innovations were

initially

> greeted with rolled eyes, but hospital officials say that has lessened.

> Nonetheless, studies by the University of Minnesota found that some

> of the safety procedures, like the pre-surgery time-outs, have

largely become

> rote.

> Clear trend lines are not expected for

> several years. Some states have found through audits that not all

errors are

> being reported, but Minnesota

> officials believe that compliance is high.

> " There's been an

> understanding by hospitals that we're not trying to get them, that

> we're really focused on what we can learn from these events, " said

> Diane C. Rydrych, the state health department official in charge of

reporting.

> E. , vice president for

> quality and patient safety at the American Hospital Association,

said hospitals

> had generally accepted that many of the 28 adverse events should

never happen,

> like giving a patient the wrong type of blood. But she said other

areas could

> be gray, like an injury caused by a malfunctioning device.

> " Anyone — I don't care

> who they are — always finds it a little provocative to be held

> accountable for something that is not within their control,

especially when you

> have dedicated yourself to doing the right thing for your patients, " Ms.

> said. Such unforgiving standards, she said, can " set an

> expectation among patients that staff will be closer to perfect than

they

> actually can achieve. "

> Even America 's Health Insurance

> Plans, the leading industry trade group, has questioned whether some

of the

> conditions on the Medicare list are always preventable.

> But V. Lee, executive director of

> the Pacific Business Group on Health, based in San Francisco , said

occasional inequity was a

> price worth paying to send the message that careless medicine will

not be

> tolerated. " I don't worry about that 1-in-100 case that can't

> be avoided, " he said, " because the benefit of not paying for the 99

> that shouldn't happen means a far greater focus on avoiding harm.

What we

> want is to encourage doctors and hospitals to get to zero. "

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