Medicare’s Double Standard
This is from an editorial in the New York Times:
Starting this month, Medicare will no longer pay hospitals for the added cost of treating patients who acquire any of 10 "reasonably preventable" conditions while hospitalized.
The policy focuses exclusively on hospitals, as directed by Congress, and lets doctors off scot-free. If surgeons leave a sponge or an instrument in a patient and have to operate again to retrieve it, the hospital will not be paid for the second operation, but the surgeons will.
Apparently, doctors are politically more powerful than hospitals.
While it is reasonable to encourage hospitals to avoid “reasonably preventable” complications by attaching some type of financial incentive or disincentive for reducing these problems, the notion that reasonably preventable means absolutely preventable and therefore always the result of inadequate care is flawed.
For example, not all UTI’s and vascular catheter infections are preventable. Nor is mediastinitis, despite all “reasonable” precautions.
As far as doctors being able to bill for wrong site surgery, it’s a relatively rare event in the first place, and my guess is most surgeons won’t bill a patient for operating on the wrong site, which is not a defensible event. On the other hand, if you take out a retained sponge that someone else left in, you should be paid.
As far as doctors having more political clout than
hospitals, would that is were so. Medicare just didn’t get around to the docs this time. Don’t worry, they will.
A better concept to encourage hospitals to lower their complication rates is to increase transparency to the health care purchasing public with respect to hospital costs, results, and morbidity. People will vote with their feet and that will help reduce errors better than any medicare mandate.