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Hospital Errors: Who Pays?

The Indianapolis Star reports that Medicare, the largest single payer of medical bills in the US, is scrutinizing conditions caused by medical error and considering not paying for them. This ought to shake up the health care industry, because where Medicare goes, commercial insurance providers like Blue Cross/Blue Shield and United HealthCare tend to follow. Medicare is considering not paying for these hospital acquired problems:
  • air embolism
  • objects left in the body after surgery
  • bed sores
  • falls
  • wrong surgery
  • catheter associated infections (either urinary or vascular)
  • transfusion reactions from being given the wrong blood type
  • hospital acquired infections
Basically, Medicare may stop paying for complications that occur from hospital care if those complications did not exist before the person was hospitalized. This comes at a time when US hospital errors have continued to rise by 3%. Healthday News reported the HealthGrades Patient Safety in American Hospital Study findings that there were 1.16 million "patient safety incidents" among the 40 million Medicare hospitalization records studied 2003-2005.
  • Those involved in the above had a 25% chance of dying. Almost 250,000 preventable deaths were reported
  • Excess costs of these "incidents"? $8.6 billion (Medicare patients 2003-2005)
  • Greatest increases? Post-op sepsis, post-op respiratory failure, bed sores
Researchers report a "chasm in quality" between the nation's top tier and bottom tier hospitals. McLeod Health in Florence South Carolina is one of those top tier medical centers, largely because over the past decade they have invested resources in process improvement, including IT. They are ranked #1 in South Carolina and the top 10% in the country for cardiac interventions. McLeod Health has automated drug dispensing, medication reconciliation, physician order entry and while the cost was high, the outcome has been worth it. They participate in the National Voluntary Hospital Reporting Initiative to help "raise the bar for Health Care Performance".

Be an informed health care consumer. Find out the HealthGrade of your facility and doctor. Ask questions. Be informed. It's your body. It's your life.

Thank you homernoh for use of photo, Hospital sunset (Phoenix AZ).
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The Healthline Editorial team writes about the latest health news, policy, and research.