Medical errors
The folks who handle Medicare payments to hospitals have come up with a novel idea for reducing medical errors that harm patients: Stop paying for them.
Last month, for instance, the University of Michigan reported that about 25 percent of hospitalized patients are outfitted with a urinary catheter, though many aren’t needed at all. And many more are left in place far longer than necessary.
The tubes trigger more than half a million urinary infections a year — the most common hospital-caused infection — which then cost additional time and money to treat. Up till now, fewer than one in 10 hospitals has required a daily check to see whether the catheters are still needed — a proven infection-reducing step.
But now Medicare has announced that, come October, it will no longer pay to treat the iatrogenic, catheter-caused infections.
Presto: “Every hospital CFO, this gets his attention.” says Dr. Steven Gordon, chief of infectious diseases at the Cleveland Clinic Foundation.
Up till now, hospitals were allowed to bill Medicare for treatment of elderly patients made necessary by their own errors or omissions — mistakes that could add $10,000 to $100,000 to the bill eventually footed by taxpayers.
Starting Oct. 1, however, Medicare will no longer pay for a variety of hopital-induced errors. Nor will hospitals be “allowed” to bill the patients for these extra costs.
Medicare administrators estimate the growing “no-pay” list will save the government about $190 million per year. And private insurance firms are watching the Medicare initiative, considering taking their own steps to make hospitals absorb the costs of errors.
It all sounds great. It’s even common sense: If you take your car to the garage and they break it, you only pay for the repair you ordered — you expect the garage to make good the cost of fixing something they broke themselves.
Since medicine is already heavily government regulated, however — nowhere near as free a market as, say, car repair — there are a few added concerns.
Medicare already fails to pay 100 percent of the amounts billed, even on “covered” procedures where doctors and hospitals do no wrong. Doctors and hospitals generally settle for 60 cents on the dollar — sometimes less.
The rest of us make up the difference. But as Medicare administrators in search of savings make treatment of their covered patients more and more punitive, less and less profitable, what’s to stop more hospitals and doctors from simply refusing to accept Medicare patients, even going back to a far less bureaucratized regime in which patients are expected to pay — gasp — cash?
For politicians, the easiest answer will appear to be, “Make it illegal to refuse.”
And it’s unlikely the 13th Amendment will give them a moment’s hesitation.