Can Punishing Medical Errors Make Hospitals Safer?
In January, Medicare cut federal payments to 769 hospitals, continuing a program of punishing hospitals for errors and avoidable complications, such as blood clots, falls and bed sores. For the first time these penalties also included hospital-acquired antibiotic-resistant infections. Mandated by the Affordable Care Act, Medicare is required to penalize the bottom 25% of the worst performing hospitals, even if they’ve shown a reduced rate of incidents from year to year. In the years since the penalties took effect, they had the unintended consequence of disproportionately reducing funding in teaching hospitals and for patients in low-income areas with limited access to services. This prompted congress to legislate a socioeconomic adjustment when evaluating hospital performance.
While the federal Agency for Healthcare Research and Quality (AHRQ) estimates that hospital-acquired conditions have declined 21% from 2010 to 2015, there were still an estimated 3.8 million hospital injuries in 2016: 115 injuries for every 1,000 patient stays. Specialized hospitals, such as those for children, rehabilitation, cancer, veterans and psychiatric treatment are exempt from the financial penalties.
Reporting by the Kaiser Family Foundation has found that readmission rates started falling in 2012 and have continued, suggesting that more hospitals have taken up preventative measures for hospital acquired infections and preventable readmissions, and that overall the impact of the penalties is less than 1% of the reimbursable amount for a re-admission.
Other countries, such as Australia, have been carefully watching the results of these policies, and in July, Australia will enact its own penalty program. However, critics of the penalization strategy argue that gross medical errors should be handled separately from programs for hospital acquired infections. Professors at Monash University argue that serious errors, known as “sentinel events,” are better addressed on a case by case basis to identify prevention measures and that a sentinel event does not necessarily reflect the overall quality of the hospital. They also suggest that the penalties could have the undesired effect of making hospitals less likely to report errors if they fear the repercussions, or encourage hospitals to only take patients with the greatest financial outcome, avoiding sicker, riskier patients.
While the repeal of the ACA has lost a lot of steam, its policies will continue to significantly affect doctors and almost-doctors in the years to come.
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