Tuesday, January 15, 2008

Medicare - On Never, Never, Never, Never Paying for Never-Never Events, Nevermore, Qouth Medicare

Never give in, never give in, never, never, never, never.

Winston Churchill, Address at Harrow School, 1941

And my poor fool is hang’d! No, no, no life!
Why should a dog, a horse, a rat, have life,
And thou has no breath at all? Thou come no more;
Never, never, never, never, never!

Shakespeare, King Lear

Quoth the Raven, “Nevermore.”

Edgar Allen Poe, 1809-1849, The Raven

I see in the January 15, 2008 Wall Street Journal “Insurers Stop Paying for Care Linked to Error” health plans are joining Medicare in never, never paying for never-never events in hospitals.

Never-never events are preventable events that should never-never have occurred. The never-never preventable complications that should never, never have taken place include.

• Objects left after surgery – a sponge, clamp, a pair of scissors

• Surgical-site infections – surgical wound infcctions due to lack of hand washing or shaving the surgical site

• Blood incompatibility – a mismatched transfusion

• Urinary tract infections due to catheters – left too long without being changed

• Hospital acquired bedsores – those not present on admission

• Falls in hospitals – those occurring in patients not strapped in and allowed to walk without assistance or support.

• Letting patients wander off or disappear – as in the disoriented, confused elderly or Alzheimer’s patients

• Artificically inseminating the wrong donor with the wrong sperm

• Operating on the wrong patient

• Performing the wrong procedure

• Using contaminated drugs or devices

• Discharging an enfant to the wrong patient

• A mother’s death or a serious infection or serious disability following a low risk pregnancy

• A patient abduction or sexual assault

• Paying for a patient’s hospitalization after an avoidable never-never event.

Aetna is following Medicare, and WellPoint, UnitedHealthcare Group, Cigna, and the Blues will shortly follow. It’s understandable why this is happening. Preventable complications are said to cost Medicare and other health plans tens of billions of dollars, at least $10,000 for each avoidable event. There are 1.7 million hospital –acquired infections each year, and 99.000 die from these infections.

Never paying for preventable complications is a logical way to save money and to prevent deaths from never-never events that should never, never have occurred. At least, it seems logical to government and health plan bureaucrats who seek to encourage hospitals to launch prevention and safety programs..

These programs work. The Pitt Country Hospital program in Greenville, North Carolina, screened all admitted patients with nasal swabs for MRSA infections, and the incidence of respiratory pneumonias dropped by 67% and catheter-related urinary track infections by 60%.

Please note the incidence didn’t drop by 100%., This makes sense. You’re dealing with chronically ill or terminally patients with compromised immunity who are prone to infections who are susceptible to end-stage complications.

Michael Maves, executive vice-president of the American Medical Association, commented,

The concept of not paying for complications that are often a biological inevitability, regardless of safety procedures, is discriminatory and could be punitive to those patients at greatest risk.

Maves has a point.

You can never, never end all complications in seriously or terminally ill patients, no matter what safety measures you undertake. Complications are a “biologically inevitability” in certain patients, but not in all.

That’s why preventive programs are worthwhile. The rub comes when deciding whether a complication was a never-never event. That will require another set of federal and health plans rules to decide. Still, preventive programs are worthwhile as evidenced by Donald Berwick’s Healthcare Improvement Institutes 2006 campaign to save 100,000 lives, which ended up saving an estimated. 103,000 hospital patients. I could go on, but never, never mind. I never, never go beyond my alloted space.

1 comment:

rlbates said...

Dr Reese, maybe you can help me. I don't quite understand why the "new" doctors who get called in to "fix" the NEVER-events shouldn't get paid (or will they). For example, the plastic surgeon who is consulted to repair the infected sternum after the heart surgery. Will they get paid for their work? Afterall, they weren't involved in the initial events that led to the problem.

I certainly agree we should strive to NEVER have these things happen, but who else is held to these standards.