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.