There’s a popular category of humor, exemplified by comedian Jeff Foxworthy, called “Redneck Humor” that goes like this: “You know you’re a redneck if …” (“… you've ever lost a loved one to kudzu,” for example.). Today, I am creating a new category, especially for us folks who often find ourselves somewhere Left-of-Center. Let’s call it Cynic Humor. Here, you try it: “You know you’re a cynic if you hear, ‘The surge is working,’ and you respond, ‘Yeah, Right!” Or, “You know you’re a cynic if you hear ‘The levees will hold,’ and you shout, ‘Yeah, Right!” Or, “You know you’re a cynic if you hear ‘Alberto Gonzales is a man of great integrity,’ and you shriek, ‘Yeah, Right!” You get the idea. Try it yourself, sometime. It’s good. Makes you feel less like you’re Jeff Foxworthy, more like you’re Lewis Black. Yeah, right!
This all started last week, when I read an Associated Press news release. “Medicare will stop paying the costs of treating infections, falls, objects left in surgical patients and other things that happen in hospitals that could have been prevented. The rule change announced this month is among several initiatives that the administration says are intended to improve the accuracy of Medicare's payment for hospital patients who receive acute care and to encourage hospitals to improve the quality of their services.”
Yeah, right!
The item continues, “Medicare payments for inpatient services will be more accurate and better reflect the severity of the patient's condition.”
Yeah, right! But wait! There’s more. A-P said, “The rule identifies eight conditions - including three serious types of preventable incidents sometimes called ‘never events’ - that Medicare no longer will pay for. Those conditions are: objects left in a patient during surgery; blood incompatibility; air embolism; falls; mediastinitis, which is an infection after heart surgery; urinary tract infections from using catheters; pressure ulcers, or bed sores; and vascular infections from using catheters.
The idea is that hospitals, not Medicare, will be expected to pick up the cost of any additional treatment needed for a preventable condition acquired in the hospital. “The hospital cannot bill the beneficiary for any charges associated with the hospital-acquired complication,” the final rules say.” Yeah, right! You can call me a cynic if you like, but I find this line of reasoning especially untenable. And, not just because it’s our famously truthful government (Yeah, right!) saying it. Many consumer organizations have hopped aboard this natural-organic-fertilizer-filled bandwagon, saying that this is a good thing, because “it will force hospitals to adhere to best practices.” Yeah, right!
My guess is that something quite different will happen. Hospitals are businesses, and, like most other businesses, are saddled with certain costs they cannot control. So, if they want to be profit-making enterprises, they work very hard at holding down the costs they can control. When other industries do this, it becomes a matter of risk/benefit analysis. When an automaker, for example, discovers that a flaw in, say, its gas tank design, or defective seat belt attachments, could cause fatalities in certain accidents, it weighs the cost of fixing that problem versus the cost of paying out any claims were such accidents to happen, and the company found to be liable because of that fixable flaw. Now, I’m not making this up. Both of these cases actually happened, with the respective car companies figuring that the cost of calling in a couple of million vehicles to replace a $2.68 (not necessarily the real cost, but representative) part would cost them more than paying off an actuarially determined number of claims resulting from the defect.
“But hospitals will be different,” you say, “They’re in business to care for people!” Yeah, right! I’m guessing that if they have an operating-room screw-up and leave a pair of pliers inside some poor bastard, many hospitals will NOT rush to call back the surgeon who messed up, and pay him or her to go back in, with the whole surgical team, to take those pliers out. No, first they’ll x-ray the crap out of the thing to be sure it’s not impinging on a vital organ, or is otherwise deemed not to be an imminent danger to the patient. Then, they’ll compute how much it would cost to remove it, versus how much they’ll be sued for if the patient ever does have a problem with that handy tool. I can tell you from personal experience that, when it comes to jury-tried medical malpractice cases, the victim usually loses. So, businesswise, it’s a good bet for the hospital to just Shut the Hell Up, wheel the patient out the front door, and hope he never passes through a metal detector.
It’s not about better care, or accountability. It’s about the money. Last year, Medicare brass said the government could save hundreds of millions of dollars a year if they stopped paying for medical errors such as operations on the wrong body part or mismatched blood transfusions. Sadly, these errors happen in abundance. The Fourth Annual HealthGrades Patient Safety in American Hospitals Study, released in April, found 1.16 million total patient safety incidents (PSIs) occurred in more than 40 million hospitalizations in the Medicare population, which is almost a three-percent incident rate. These incidents were associated with $8.6 billion of excess cost during 2003 through 2005. Ten out of 16 of the patient safety incident rates studied worsened from 2003 to 2005, on average, by more than 11.5 per cent. Now, here’s a scary number: Of the 284,798 deaths that occurred among patients who developed one or more patient safety incidents, 247,662 -- that’s an appalling 87 per cent -- were potentially preventable. Medicare beneficiaries who developed one or more patient safety incidents had a one-in-four chance of dying during the hospitalization during 2003 to 2005.
So, with this track record, when I hear that an offending institution will have to pay to fix its errors, and will thereby become less-likely to cause those errors, I’m thinking, “Yeah, right!” Medicare covers about 43 million elderly and disabled people. The program's expenses in 2006 totaled about $408 billion. Sounds like a lot, but do the math. Averaged out, this is only about $9,400 per recipient. Not a lot when you know what hospital care costs these days, but apparently too much to bear for a benefits system that has billed itself as the primary healthcare safety net for this vulnerable group.
I have a better idea. Hospitals that do screw up, botch an operation, switch a blood bag, drop a patient off a gurney, or leave a foreign object inside a patient, must NOT be allowed to bill anybody for that, as they do now. I still get bills from hospitals for medical procedures that killed off one or the other of my relatives years ago, and I think that’s despicable. Instead, let Medicare mandate, “No more bills for screw-ups and botched operations,” – and let our Medicare officials decide how to define “botched.” This would better serve the purpose of holding hospitals accountable and encouraging better care, instead of simply not reimbursing hospitals that honestly try to correct their errors. Pay them only for doing things right. A novel suggestion, surely, and one you could easily apply across our culture. Because you and I know that nobody would want to take money for doing their jobs so badly that they actually kill someone. All together now: Yeah, right!
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