QUALITY: Stopping the Mistakes

All health systems, even good ones, make mistakes. Some have horror stories. Surgical sponges left inside of patients, deadly infections that come from within the hospital rather than the outside world, operations on the wrong body part. Within the past few years, Virginia, Maryland, and DC have enacted laws requiring hospitals to disclose such patient injuries to regulators, The Washington Post reports. The goal is to make the system safer.

Regulators are hoping to reduce preventable deaths and injuries, sometimes called "never events" because they should "never" happen. According to the Post, one hospital in Northern Virginia reported about two dangerous blood infections for every 1,000 IVs inserted in patients. Currently, insurance companies generally reimburse hospitals for medical errors. If, for example, a patient were to come into the hospital for a low cost procedure, and get an infection from an IV because their doctor did not wash his hands, the hospital would bill the insurance company for the much higher cost of treating the hospital acquired infection. As the Post puts it, "if a lawn service mowed down your rosebush while cutting the grass, you wouldn't pay the company to replace it."

Some regulators and insurance providers are starting to come up with strategies to fight against these "never events" by realigning payment incentives. Medicare already implemented this system -- there are specific "never events" that Medicare won't pay hospitals for, including ventilator-associated pneumonia and hospital acquired staph infections. Some hospitals in Maryland are voluntarily cooperating with insurers who want to follow Medicare's example; agreeing to forgo reimbursement for mistakes such as transfusing people with the wrong blood type, or performing surgery on the wrong side of the body, reports the Post. Anthem Blue Cross and Blue Shield of Virginia also stopped paying for a small number of serious, preventable mistakes, such as operating on the wrong patient, or leaving foreign objects inside the patient after surgery.

Clinicians and hospital workers are only human, and people do make mistakes. But the potentially cataclysmic consequences of mistakes in patient care mean that hospitals and clinicians -- and the systems they work in -- need to strive toward perfection in care delivery. Doctors don't intend to make mistakes, and patients and their families don't like feeling victimized. (In fact, many have found that a sincere "I'm sorry" from doctors does a lot to alleviate the burden of medical malpractice lawsuits, reports the Associated Press.) Other simple strategies, such as Dr. Peter Pronovost's hygiene checklist, have helped hospitals lower rates of hospital acquired infections when implemented, but no method is foolproof. Health care providers are also worried about understaffing -- how strict is too strict for nursing staffs that are already chronically understaffed? Ultimately, the goal of changing payment incentives is to improve the health care system, to reduce medical errors, increase quality, lower cost, and improve patient safety.