Saturday, September 15, 2007

Another Step along the Way

For years we believed that doctors did the best they could, but sometimes things just didn’t work out. Doctors got paid for what they did and if things went wrong they also got paid for fixing them. Hospitals got paid, too.

In recent times, we have come to understand that medical mishaps don’t just happen. Most of them can be prevented by following recommended protocols.

That raises the question of why doctors and hospitals should be paid for treating patients for the consequences of preventable medical errors.

The emerging conclusion is that they shouldn’t. It started with refusing to pay for so-called “never events,” like amputating the wrong leg or repairing the wrong shoulder. Now serious consideration is being given to not paying for things like the treatment of hospital-acquired infections.

I predict that it will happen and the effect will be to give a big boost to a change in medical culture that is already under way.

At present, if hospital trustees are told by their executives that the incidence of hospital-acquired infections in their hospital is too high, they are likely to respond with concerned tongue clucking and the opinion that perhaps someone should look into it. The executives are expected to do what they can, so long as they don’t interfere with medical practice.

But if those same executives report that the hospital is losing income because of such infections, the trustees are much more likely to rise into action. Infections are medical business that trustees are apt to stay out of. But money is their province and if there is a money problem they are much more likely to expect their executives to fix it.

Of course, fixing the problem will require “interfering” in medical practice. But since the purpose is ostensibly financial and not clinical, the efforts of the executives are much more likely to be accepted.

Effective reform of health care requires dealing with the delivery system as a whole, not just its non-clinical part. Anything that facilitates that, like not paying for medical errors, will move reform another step along the way.

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