Bucks
Medicare Changes - Grandview & Quakertown Hospital Respond
Dear Friends,
Good morning. A few weeks ago, I wrote a column about Dr. Larry Miller, the surgeon who repaired my shoulder. He told me that the American health system was broken and needed fixing. You and I know that hospitals and physicians blame insurance companies for the accelerating costs of medical care. On the other hand, insurance companies blame hospitals and physicians for errors. Making matters worse, trial lawyers blame all of the above and visa versa.
I thought of Miller’s comments when I read that Medicare will stop paying hospitals for the extra costs of treating certain patients whose illnesses are compounded by preventable errors. I wondered what impact those changes would make to local hospitals like Grandview and St. Luke’s Quakertown?
The Bush administration predicts that the [Medicare] changes will save lives and millions of dollars. “Among the conditions that will be affected are bedsores, or pressure ulcers; injuries caused by falls; and infections resulting from the prolonged use of catheters in blood vessels or the bladder,” Robert Pear wrote in the New York Times (Aug. 19).
“In addition, Medicare says it will not pay for preventable events like leaving a sponge or other object in a patient during surgery and providing a patient with incompatible blood or blood products…
“If a patient goes into the hospital with pneumonia, we don’t want him to leave with a broken arm,” the report continued.
“The Centers for Disease Control and Prevention estimates that patients develop 1.7 million infections in hospitals each year, and it says those infections cause or contribute to the death of 99,000 people a year-about 270 a day,” Pear wrote.
I talked with Stuart Fine, the President and C.E.O. of Grandview Hospital, and Edward Nawrocki, the President of St. Luke’s Quakertown Hospital for their reactions to the news.
“The [Medicare] changes will have minimal impact on our hospital,” Nawrocki began. “It would affect less than one percent of the hospital’s reimbursement. Besides, egregious errors don’t happen here.”
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Nawrocki illustrated the problems of accidents with a ludicrous, though humorous example. A few years ago, an intoxicated female came to Quakertown’s emergency facility. Unable to find the lavatory in time, she urinated on the floor, causing her to slip and fall. She broke a bone and promptly sued the hospital. Although she dropped the suit, the incident points out the unknown. How will the government judge a case like this?
More to the point, how will Medicare write the new rules for 2008? “The devil’s in the details,” Nawrocki laughed, then adding seriously, “Still, the spirit of Medicare’s changes is appropriate and good.”
Grandview Hospital’s opinions were similar.
“The Medicare changes won’t have much of an impact on Grandview,” Fine began. “We have hundreds of thousands of out-patients’ cases and tens of thousands of in-patients’ cases each year.”
What’s the incident of error, I asked him?
“Maybe a dozen cases,” Fine replied. “We all agree that hospitals must take responsibility for an error if the hospital is at fault,” he said. And then he gave an illustration.
“A patient is admitted and appears not to have dizziness symptoms, but falls,” Fine began. “Is that a hospital error? That’s very different from a patient with a history of dizziness and falling. Not every fall is an error.”
Fine predicted that there will be gray zone cases, and a process for debate. “If a car has a malfunction caused by the manufacturer, you recall the car for a correction,” he said. “But there’s a difference between cars and people. You can’t treat every patient the same way.”
One element is missing from the proposed changes to Medicare’s rules. It concerns the penalty for doctors who commit errors. “An errant doctor, who may also be culpable, can get paid for operating again,” the New York Times lead editorial opined (Aug. 21). “In future years, Medicare needs to consider reforms in physician payments as well.”
Absolutely right, say I.
Both Fine and Nawrocki hope that the new rules will be beneficial. “Still, Fine concluded, “We shouldn’t let the tail wag the dog.” We’ll just have to stay tuned.
Sincerely,
Charles Meredith