I read somewhere recently that compliance with hand washing standards in American hospitals is less than 50%. That alone is enough to make me thankful that Jay and I have chosen a home birth for our baby this spring, but it also raises lots of questions about medical care in general. If something as simple and effective as hand washing is being skipped on a regular basis, what other simple mistakes are being made that end up costing the patient and the patient’s health insurance company extra aggravation and money?
Medicare is going to stop paying hospitals to make mistakes, starting this fall. A list of eight preventable medical errors that result in extra medical charges will no longer be reimbursed by Medicare – and the hospital will not be able to bill the patient either. The list includes infections from urinary catheters left in place too long, injuries from preventable falls, and charges stemming from surgical instruments left in a body after surgery.
Hospitals are scrambling to improve their standards of care in an effort to prevent simple mistakes that turn into costly errors. From the simple (hand washing spies) to the complex (surgical sponges equipped with RFID that will sound an alarm if left in an incision site), hospitals are trying all sorts of new ways to cut down on infections and complications caused by human error.
This is a great idea in theory. Money is always a great motivator, and if hospitals know that they will have to absorb the additional costs associated with fixing their mistakes, they will be more inclined to implement programs to prevent errors from occurring in the first place. But how will we know that the hospitals aren’t just increasing their fees for non-Medicare patients to cover the loss in revenue from Medicare when hospital error is involved in a patient’s charges? And who will monitor to make sure that doctors and hospitals are not just burying the charges under different codes in a patient’s bill? Over the years, doctors have become accustomed to individual health insurance policies that exclude pre-existing medical conditions, and many have found ways to bill around the exclusions. This is one of the reasons that some major health insurance carriers in Colorado – including Anthem Blue Cross Blue Shield – have started using rate increases instead of pre-existing condition exclusion riders during initial underwriting.
Another potential problem I see here would be if hospitals become leery about aggressively treating infections that were caused by hospital error. If they know that they will not be paid for any of the treatment, might they decide to cut corners and use lower-cost (and maybe less effective) treatment protocol when the condition being treated is on Medicare’s no-pay list?
It remains to be seen how the new payment guidelines will effect treatment for American seniors and people with disabilities who are covered by Medicare. I’d like to think that at the very least we could get every health care provider sold on the idea of washing their hands before and after every patient.