Medicare should NOT pay for errors-but what are "errors"

Implications: - Some studies show that medical errors continue to increase despite an intense focus on this issue over the last recent years. This decision by CMS should bring even more attention to this whole area of patient safety and error prevention - There will need to be increased documentation to "prove" that an infection, for example, was present at admission or was not preventible or forseeable. This might increase the cost of delivering care. - The debate will continue  as to what is preventible - MCOs and other payers might well jump on the bandwagon and start parsing what is considered "allowable"  

Analysis: I addressed this same issue in a previous post on May 30, 2007 titled "Medicare should not pay for unsafe care".


Just about everyone in healthcare will agree that the goal should be to provide safe care, with as few errors or mishaps as possible. In principle it is a sound rationale NOT to pay for errors, or even for increased length of stay and increased costs to RECOVER from errors. The major cause of unintended increased length of stay (LOS) in the typical hospital stay is healthcare acquired infections (HAI). The general theory is that these nosocomial infections are ALL preventible. Are they?

I predict that hospitals and physicians will be placed in the defensive mode of over-documenting just to prove that they don't OWN an infection or other expensive patient condition , or that a certain complication or comorbidity could not be REASONABLY foreseen and prevented.

There will be lots of confusion and fingerpointing as payers try NOT to pay and providers try to get as much reimbursement as possible.
As I said in that May 5 post "The only concern I have is how CMS will ascertain and quantify what is considered preventible. While many scenarios are pretty clear, how do you decide definitively in each case whether or not the patient was admitted with MRSA  that "flared" during hospitalization; or which hospital "owns" a line infection if a patient is transferred with an IV then becomes septic?

In principle, everyone should benefit from this CMS decision. Providers will theoretically practice more safe, judicious care, paying attention to things like positive patient ID and infection control procedures. The patient will benefit from safer care.  But (much as I hate the over-used expression) I have to say it: "the devil is in the details"