If you get a bad meal at a restaurant, you expect
the manager to tell you it's on the house. Similarly, if the plumber wrecks
your sink instead of fixing it, you don't pay him. That's the American way of
commerce. Do the job right or forget about getting paid in full.
Except for doctors and hospitals. When they foul up big time, they often get
paid more, the result of more surgeries and extended hospital stays. And that
adds billions to the nation's medical bill--not to mention the toll in patient
suffering and even deaths.
But there's a move (finally) by some of
America's biggest companies to persuade hospitals to waive charges if they
commit the most egregious medical mistakes. These are often the cases that
make headlines: A surgeon operates on the wrong side of someone's brain, for
instance. Or a patient gets the wrong drug, or the wrong dose, with fatal
results. Things that should never happen. That's why they've been dubbed
"never events."
In recent weeks, a national coalition of large companies and a Chicago
business group representing more than 80 local employers called on U.S.
hospitals to stop billing for costs related to 28 such "never"
events.
Our query: Why didn't this happen years ago?
If you believe, as we do, that doctors and hospitals should be paid bonuses
for superior life-saving performance, then it follows that they should not be
paid for terrible performance that hurts patients. A hospital--or a
doctor--shouldn't benefit from a serious preventable error. Indeed, many
hospitals are already canceling bills under some of these "never"
circumstances, according to Richard Umbdenstock, president-elect of the
American Hospital Association.
That's the right course, but it's only a start. After all, many of those
monumental mistakes are fodder for malpractice suits and settlements worth
more than the original bills for the botched procedures. Most of those kinds
of mistakes are, thankfully, relatively rare.
What about all the rest? The effort to cut mistakes that kill thousands and
cost billions can't stop at "never" events. It must include other
preventable problems that hurt patients and cost big money, such as some
hospital-borne infections. Three recent studies offered evidence that
infections acquired in hospitals arise in many cases from poor hygiene
procedures in hospitals, not from how sick patients are when they're admitted.
In other words, many of these infections are preventable. And the benefits of
cutting those infections would be huge: Pennsylvania officials reported that
those who caught infections in the hospital stayed an average of 16 days
longer, were charged an average of $153,871 more--and were almost six times
more likely to die.
Figuring which of these errors is preventable and which isn't poses huge and
complex questions for doctors, hospitals, insurers and employers. One thing is
certain: This isn't--can't be--about persecuting doctors for bad outcomes.
Some treatments fail, not because of the doctor's skill, but because of other
factors, including a patient's overall health. There's no guarantee of success
with medicine, no matter how skilled the doctor, or how excellent the
hospital. Doctors and hospitals can do all the right things, and the result
can still be disappointing. Humans don't always respond the same way to the
same drugs or procedures.
The point is to create incentives for doctors and hospitals to fully report
all mistakes and, most important, share that information. Not all errors are
preventable, but many are. They're the result of badly designed hospital
systems or sloppy work. As Dr. Donald Berwick, head of the non-profit
Institute for Healthcare Improvement, told a reporter: "This isn't a
matter of doctors and nurses' trying harder not to harm people. Safety isn't
automatic. It has to be designed into the system."
Tracking mistakes is the best way to devise new ways to avoid them. And that
is critical to improving health care in America.
Yes, docking doctors and hospitals for
some of those mistakes may discourage some reporting. The prospect of
not getting paid isn't appealing.
But there's something far greater at stake here, something doctors and
hospitals have dedicated themselves to: the health of their patients.
How much would it be worth to doctors or hospitals if they never again had to
explain to a patient--or an incredulous family--why the surgeon operated on
the left side instead of the right? Or why a scribbled prescription was
deciphered wrong, with catastrophic results? Or why artificial insemination
was done with the wrong donor sperm or egg? Or why a patient who came in for
minor cosmetic surgery ended up in the morgue? Or ...