Monday, August 20, 2007

NY Times From Sunday

This article is mildly disturbing, if you think about it. On the surface, Medicare refusing to pay for "avoidable medical errors" would seem to make sense. But just delve a little deeper and such a policy ought to frighten most physicians. Take for example IV catheter site infections. Certainly if you leave a peripheral line in for 12 days and it causes a thrombophlebitis, one would consider that an avoidable medical error. One that could be avoided by implementation of an institutional policy that requires IV sites to be changed every three days. But what about the patient who comes in with perforated diverticulitis and you put in an emergency central line for resuscitation prior to the OR and, three days later, blood cultures show staph growing from the line. It's technically a line infection. Was it avoidable? Is it an error? Who decides? This opens a huge can of worms. What about any post operative complication: DVT, UTI's, wound infections? Can't you just see some bureaucrat from Medicare deciding that these were "avoidable" and therefore will not be covered under the patient's plan? And if Medicare won't pay, the bill goes to the patient who is going read the phrase "avoidable medical cost/error" and head straight to his/her area tort lawyer.

5 comments:

Sid Schwab said...

Yeah, I wrote about this one, too. Fertile soil for unintended consequences. Time will tell...

Anonymous said...

Medicare says the bill can't go to the patients, if it has been determined by them to be not covered, and caused by reasons that could have been avoided.

Anonymous said...

And even if Medicare allowed the bill to go to the patient, no "area tort lawyer" would take the patient's complaint because of the low potential for financial compensation.

In all likelihood, an "area tort lawyer" would shoo a prospective client out the door with closing words to contact their state representative.

Buckeye Surgeon said...

So what happens to the costs? Is it an empty gesture? The hospital doesn't get paid?

Cary said...

I believe the hospital takes the loss.

I agree that Medicare shouldn’t have to be held responsible for the costs for medical errors such as a left behind sponge, but those cases such as the example you pointed out, are a whole other story.

To bad we can't use the honor system, because the only one who knows the difference between a fall and a drop, or whether the patient acquired bedsores due to neglect is the individual in charge.