QUALITY: California Medical Error Reports Raise New Payment Questions

California now requires that hospitals inform state officials of substantial injuries to patients. The first batch of reports are in: 1,002 cases of "serious medical harm" in the 10 months starting last July, according to the LA Times. By "serious" the state means things like taking out the wrong person's appendix, patients dying after being given the wrong drug, a nine-day-old baby not getting enough oxygen when a ventilator hose is hooked up according to a diagram that was drawn backwards.

The point of error reporting isn't hand wringing or finger pointing. It's coming up with solutions to improve patient safety. The California Department of Public Health can now fine hospitals over safety errors. And increasingly, Medicare, some big health insurers and now a few states are deciding that they want to make patient safety good business—or at least they want to make safety errors bad business. They won't pay for the care needed to fix the mistakes. You break it, you pay.

The newspaper reported that California Assemblyman Mike Feuer has introduced legislation to ban the state MediCal program from paying for the same preventable errors that Medicare has announced it will no longer pay for. It's not clear from the newspaper report or this related Wall Street Journal blog post how much support Feuer has, or how likely his bill is to become law. But it is clear that more policymakers at the state and federal level, instead of the usual bromides about how we've got the best medical care in the world, are thinking about where we aren't doing so well, and how to improve it.

One last point—Judging from some comments we've seen on other blogs, some people mistakenly think the patient who is the victim of the error somehow doesn't get treated or has to foot the bill. No, the hospital just doesn't' get extra from Medicare, the insurer, or perhaps eventually MediCal, for treating the patient for an avoidable medical error. The idea is to give the hospital financial incentives for getting rid of those problems that can be gotten rid of.