"D. C. Sessions" <dcs@lumbercartel.com> wrote in message
news:jkpt85-1oi.ln1@news.lumbercartel.com...
In message <xMMuj.41516$yE1.27616@attbi_s21>, Skeptic wrote:
"Ilena Rose" <BIA@mundo.com> wrote in message
news:e02mr31mvnkggh68o0rjdra44sde0phlnm@4ax.com...

WASHINGTON - It's a new way to push for patient safety: Don't pay
hospitals for their errors.

Beginning Oct. 1, Medicare no longer will cover extra-care costs for
eight preventable hospital errors. Nor can hospitals bill the injured
patient for those extra costs.

"Money talks," says Dr. Steven Gordon, infectious disease chief at the
Cleveland Clinic Foundation. "Every hospital CFO, this gets their
attention."

- - -

Medicare's targets

*Urinary tract infections from catheters

This is old news. This is also one of the biggest reasons we should be
very
fearful of a government run healthcare system. UTI's are an absolutely
unavoidable outcome in a percentage of patients with catheters in
place.
The people that come up with this insanity simply don't have a clue.

Is it possible to prevent every last single catheter infection?
(Aside from never using catheters, anyway) No, of course not.
Is the alternative to give care providers carte blanche to be
paid for bad patient outcomes regardless of substandard care?
One would hope not. Is the alternative to require the equivalent
of a Board of Inquiry on every nosocomial infection? Not cost-
effective.

If we take all of this out of the "blame" space and put it in
a "quality improvement" space, though, you get a different
perspective. The current incentive structure, frankly, is a
"cost plus" system where providers have a financial incentive
to provide substandard care which, when it causes adverse
patient outcomes, *increases* their revenues.

I don't see that. Substandard care can result in medical complications.
Medical complications are costly to fix and can be devastating to a
physician's credibiltiy. A commonly used example is the
gastroenterologist
perforating a colon and making money on the surgical repair. People that
make those sorts of claims simply do not understand that the doctor
repairing the colon will be a busy general surgeon who was not involved in
the case and now has to cancel his clinic or come in in the middle of the
night for an urgent surgery. The GI doc who perforated gets nothing
except
scrutiny.

"Skeptic" <bcs002b@yahoo.com> wrote in message
news:Sg6vj.42739$9j6.31268@attbi_s22...

I don't see that. Substandard care can result in medical complications.
Medical complications are costly to fix and can be devastating to a
physician's credibiltiy. A commonly used example is the gastroenterologist
perforating a colon and making money on the surgical repair. People that
make those sorts of claims simply do not understand that the doctor
repairing the colon will be a busy general surgeon who was not involved in
the case and now has to cancel his clinic or come in in the middle of the
night for an urgent surgery. The GI doc who perforated gets nothing except
scrutiny.

This happened to our departmental secretary. She was a lady who
weighted exactly the ideal weight for her height, and after the surgery to
repair the perforation, looked 5-6 months pregnant for about 1 year. She
lost 6 weeks of work, and got billed about $35,000 for the "repair." Errors
are highly profitable to the system.

In message <13rrsrii43e7qf5@corp.supernews.com>, George Conklin wrote:
"Skeptic" <bcs002b@yahoo.com> wrote in message
news:Sg6vj.42739$9j6.31268@attbi_s22...

I don't see that. Substandard care can result in medical
complications.
Medical complications are costly to fix and can be devastating to a
physician's credibiltiy. A commonly used example is the
gastroenterologist
perforating a colon and making money on the surgical repair. People
that
make those sorts of claims simply do not understand that the doctor
repairing the colon will be a busy general surgeon who was not involved
in
the case and now has to cancel his clinic or come in in the middle of
the
night for an urgent surgery. The GI doc who perforated gets nothing
except
scrutiny.

This happened to our departmental secretary. She was a lady who
weighted exactly the ideal weight for her height, and after the surgery
to
repair the perforation, looked 5-6 months pregnant for about 1 year.
She
lost 6 weeks of work, and got billed about $35,000 for the "repair."
Errors
are highly profitable to the system.

NB, the "system" here includes more than the two MDs listed,
although (like quarterbacks) they're the ones who get the
attention. Whether the MD who was on watch for the original
problem was the one who ended up submitting a bill for the
repair or not, and regardless of "blame," the /hospital/
takes incidents like this as revenue.

Now look at the list of items headed for noncompensation and
appreciate that a lot of them are in the "team effort" group.
Sponge miscounts, for instance. "Command responsibility" or
not, it is _not_ the surgeon who is supposed to be keeping
personal track of each sponge, and if I ever find out that
a surgeon planning to work on me /does/, I'm getting someone
else -- I want his attention on other things.

Instead, that sponge count is (IIRC) the responsibility of
an OR nurse who may well be working on her 12th hour on her
feet in a schedule that has her working both night and day
shifts (cost cutting, remember) and regardless of overtime
regs she hasn't had 24 hours straight off for six days.
Which might not be so bad except as another cost-cutting
measure the staffing has been cut back so that her workload
is more than she normally could keep track of anyway even
if she hadn't missed lunchbreak to catch up on paperwork and
is running low on blood sugar.

Hey, it saves on health care costs, right?

So keep in mind that since individual patients simply don't
have any negotiating power, and since the cost of running
a Board of Inquiry on every adverse outcome is prohibitive,
it may well be that pushing the cost of (at least some)
nonquality onto the caregivers *may* be the best shot that
MDs have for getting adequate support -- who aren't dead
on their feet.

In message <Sg6vj.42739$9j6.31268@attbi_s22>, Skeptic wrote:


"D. C. Sessions" <dcs@lumbercartel.com> wrote in message
news:jkpt85-1oi.ln1@news.lumbercartel.com...
In message <xMMuj.41516$yE1.27616@attbi_s21>, Skeptic wrote:
"Ilena Rose" <BIA@mundo.com> wrote in message
news:e02mr31mvnkggh68o0rjdra44sde0phlnm@4ax.com...

WASHINGTON - It's a new way to push for patient safety: Don't pay
hospitals for their errors.

Beginning Oct. 1, Medicare no longer will cover extra-care costs for
eight preventable hospital errors. Nor can hospitals bill the injured
patient for those extra costs.

"Money talks," says Dr. Steven Gordon, infectious disease chief at the
Cleveland Clinic Foundation. "Every hospital CFO, this gets their
attention."

- - -

Medicare's targets

*Urinary tract infections from catheters

This is old news. This is also one of the biggest reasons we should be
very
fearful of a government run healthcare system. UTI's are an absolutely
unavoidable outcome in a percentage of patients with catheters in
place.
The people that come up with this insanity simply don't have a clue.

Is it possible to prevent every last single catheter infection?
(Aside from never using catheters, anyway) No, of course not.
Is the alternative to give care providers carte blanche to be
paid for bad patient outcomes regardless of substandard care?
One would hope not. Is the alternative to require the equivalent
of a Board of Inquiry on every nosocomial infection? Not cost-
effective.

If we take all of this out of the "blame" space and put it in
a "quality improvement" space, though, you get a different
perspective. The current incentive structure, frankly, is a
"cost plus" system where providers have a financial incentive
to provide substandard care which, when it causes adverse
patient outcomes, *increases* their revenues.

I don't see that. Substandard care can result in medical complications.
Medical complications are costly to fix and can be devastating to a
physician's credibiltiy. A commonly used example is the
gastroenterologist
perforating a colon and making money on the surgical repair. People that
make those sorts of claims simply do not understand that the doctor
repairing the colon will be a busy general surgeon who was not involved
in
the case and now has to cancel his clinic or come in in the middle of the
night for an urgent surgery. The GI doc who perforated gets nothing
except
scrutiny.

Unlike many who prefer to demonize the medical professions, I
consider the generally excellent care that patients receive to
be a testament to the ethics and professionalism of the care
givers *despite* a system that leans in the opposite direction.
However, wouldn't it be better to not "place a stumbling block
before the blind?" Let's remove the perverse incentive structures.

We don't need to get into finger-pointing on each and every
adverse outcome to recognize that AT AN AGGREGATE LEVEL:
* Hospitals are large enough that nosocomial infection rates average
out,
* Policies, procedures, and supervision affect those rates,
* Pushing the cost of adverse outcomes to the hospital incents
reduction of those rates overall,
* Pushing the cost of adverse outcomes to patients at best removes
an incentive to improve care and at worst incents poor care.

Example: despite Semelweiss being in his grave lo these many years,
the largest single factor in nosocomial infections is *still*
that caregivers don't take simple hand-disinfection precautions
between patients. THAT is correctable -- but not when the
"cost of nonquality" is being externalized. Make the hospital
pay for those infections and I guarantee you it won't be long
before there is a glove dispenser and recepticle at the entrance
to every patient room and an incident report for every time a
caregiver is either (a) wearing gloves outside of rooms or
(b) _not_ wearing them in rooms.

I agree washing hands is an area that can be (and has been) greatly
improved. I do not agree that a hospital simply eat the bill for every
nosocomial infection. Again, they can be reduced but not eliminated.
Things can be clean, not sterile. Infections can even occur in a sterile
operating room environment where everyone involved wears clean scrubs,
washes their hands, gowns and gloves, wears hats and masks.... yet
infections still occur. So in regular patient beds, infections will
occur.

You're still arguing from "blame." This isn't a malpractice court,
this is "quality improvement." The problem with "blame" is that it
only allows two possible strategies: "off with their heads!" and
"inshallah." We agree that the first isn't desirable.

Historically, the second is a reasonable alternative when there was
so little that could be done to ensure a positive outcome. The
local equivalent of "inshallah" is pretty much part of the cultural
history of medicine: do what you can and then pray.

Now let's move beyond that false dichotomy. Medicine has learned
to use statistics, so perhaps it's time to move on to statistical
quality improvement:

In an industrial environment, we don't consider every defective
product a source for personal blame (in some fields, like mine,
it's actually possible to calculate the unavoidable loss of yield
due to the laws of physics.) On the other hand, we don't push the
risk for those defects down to our customers, either. We, in effect,
perform the "insurance" risk-pooling for them by factoring yield
loss into our cost structure.

THAT incents us to reduce the cost of nonquality rather than incenting
us to reduce costs irrespective of quality issues and (first order)
increasing our revenues by shipping junk that has to be replaced.
This is a pretty basic matter of economics: reducing the externalization
of negatives.

So -- once you take the blame aspect out of the matter, what you're
looking at here is the application of a quality improvement process
to the practice of medicine.

It's either that, or postulate the the economics of health care
somehow violates some of the most basic principles of economics
and of statistics (upon which quality control depends.) If that's
your thesis, I anxiously await your detailed analysis.

I don't have a thesis... just practical knowledge and first hand
experience.

You are, in effect, arguing that the *economic* (not moral) cost of
nonquality care should be borne by the patient rather than the caregivers.
In situations where the patient has a substantial contribution to outcomes
(physical therapy comes to mind) that's a very reasonable _economic_
strategy.

At the other end of the spectrum, though, there is a distinct contribution
to quality of outcome based on quality of care. One would, professionally
speaking, certainly like to think so. So, one should ask, what is the
better _economic_ strategy in that case? Economic theory is pretty
settled
that externalization of costs produces bad decisions, so it follows that
the costs of nonquality should be kept as close as possible to the
decisions
that influence quality.

Again, as a process-improvement strategy I would argue that, for instance,
a payor should determine a reasonable target for nosocomial infection
rates.
(As you point out, they are to some degree inevitable.) Allowing costs
for
that rate as a surcharge on base costs provides coverage for the
unavoidable
ones; any extras would be borne by the caregiver. Caregivers meeting the
achievable quality level don't end up short, and those who don't aren't
allowed to pass along the consequences of their own decisions.

"Skeptic" <bcs002b@yahoo.com> wrote in message
news:Sg6vj.42739$9j6.31268@attbi_s22...

"D. C. Sessions" <dcs@lumbercartel.com> wrote in message
news:jkpt85-1oi.ln1@news.lumbercartel.com...
In message <xMMuj.41516$yE1.27616@attbi_s21>, Skeptic wrote:
"Ilena Rose" <BIA@mundo.com> wrote in message
news:e02mr31mvnkggh68o0rjdra44sde0phlnm@4ax.com...

WASHINGTON - It's a new way to push for patient safety: Don't pay
hospitals for their errors.

Beginning Oct. 1, Medicare no longer will cover extra-care costs for
eight preventable hospital errors. Nor can hospitals bill the injured
patient for those extra costs.

"Money talks," says Dr. Steven Gordon, infectious disease chief at
the
Cleveland Clinic Foundation. "Every hospital CFO, this gets their
attention."

- - -

Medicare's targets

*Urinary tract infections from catheters

This is old news. This is also one of the biggest reasons we should
be
very
fearful of a government run healthcare system. UTI's are an
absolutely
unavoidable outcome in a percentage of patients with catheters in
place.
The people that come up with this insanity simply don't have a clue.

Is it possible to prevent every last single catheter infection?
(Aside from never using catheters, anyway) No, of course not.
Is the alternative to give care providers carte blanche to be
paid for bad patient outcomes regardless of substandard care?
One would hope not. Is the alternative to require the equivalent
of a Board of Inquiry on every nosocomial infection? Not cost-
effective.

If we take all of this out of the "blame" space and put it in
a "quality improvement" space, though, you get a different
perspective. The current incentive structure, frankly, is a
"cost plus" system where providers have a financial incentive
to provide substandard care which, when it causes adverse
patient outcomes, *increases* their revenues.

I don't see that. Substandard care can result in medical complications.
Medical complications are costly to fix and can be devastating to a
physician's credibiltiy. A commonly used example is the
gastroenterologist
perforating a colon and making money on the surgical repair. People that
make those sorts of claims simply do not understand that the doctor
repairing the colon will be a busy general surgeon who was not involved
in
the case and now has to cancel his clinic or come in in the middle of the
night for an urgent surgery. The GI doc who perforated gets nothing
except
scrutiny.

This happened to our departmental secretary. She was a lady who
weighted exactly the ideal weight for her height, and after the surgery to
repair the perforation, looked 5-6 months pregnant for about 1 year. She
lost 6 weeks of work, and got billed about $35,000 for the "repair."
Errors
are highly profitable to the system.

"D. C. Sessions" <dcs@lumbercartel.com> wrote in message
news:9qa195-n3h.ln1@news.lumbercartel.com...
In message <13rrsrii43e7qf5@corp.supernews.com>, George Conklin wrote:
"Skeptic" <bcs002b@yahoo.com> wrote in message
news:Sg6vj.42739$9j6.31268@attbi_s22...

I don't see that. Substandard care can result in medical
complications.
Medical complications are costly to fix and can be devastating to a
physician's credibiltiy. A commonly used example is the
gastroenterologist
perforating a colon and making money on the surgical repair. People
that
make those sorts of claims simply do not understand that the doctor
repairing the colon will be a busy general surgeon who was not
involved
in
the case and now has to cancel his clinic or come in in the middle of
the
night for an urgent surgery. The GI doc who perforated gets nothing
except
scrutiny.

This happened to our departmental secretary. She was a lady who
weighted exactly the ideal weight for her height, and after the surgery
to
repair the perforation, looked 5-6 months pregnant for about 1 year.
She
lost 6 weeks of work, and got billed about $35,000 for the "repair."
Errors
are highly profitable to the system.

NB, the "system" here includes more than the two MDs listed,
although (like quarterbacks) they're the ones who get the
attention. Whether the MD who was on watch for the original
problem was the one who ended up submitting a bill for the
repair or not, and regardless of "blame," the /hospital/
takes incidents like this as revenue.

Now look at the list of items headed for noncompensation and
appreciate that a lot of them are in the "team effort" group.
Sponge miscounts, for instance. "Command responsibility" or
not, it is _not_ the surgeon who is supposed to be keeping
personal track of each sponge, and if I ever find out that
a surgeon planning to work on me /does/, I'm getting someone
else -- I want his attention on other things.

Instead, that sponge count is (IIRC) the responsibility of
an OR nurse who may well be working on her 12th hour on her
feet in a schedule that has her working both night and day
shifts (cost cutting, remember) and regardless of overtime
regs she hasn't had 24 hours straight off for six days.
Which might not be so bad except as another cost-cutting
measure the staffing has been cut back so that her workload
is more than she normally could keep track of anyway even
if she hadn't missed lunchbreak to catch up on paperwork and
is running low on blood sugar.

Hey, it saves on health care costs, right?

So keep in mind that since individual patients simply don't
have any negotiating power, and since the cost of running
a Board of Inquiry on every adverse outcome is prohibitive,
it may well be that pushing the cost of (at least some)
nonquality onto the caregivers *may* be the best shot that
MDs have for getting adequate support -- who aren't dead
on their feet.

The patient never knows who is responsible and will never be able to find
out. But the bill must be paid in all cases, and insurance companies have
no problem paying for errors. And hospitals have little incentive for
lowering error rates as long as it results in more profitable business.

"George Conklin" <nil@earthlink.net> wrote in message
news:13rs71j4tt7qibc@corp.supernews.com...

"D. C. Sessions" <dcs@lumbercartel.com> wrote in message
news:9qa195-n3h.ln1@news.lumbercartel.com...
In message <13rrsrii43e7qf5@corp.supernews.com>, George Conklin wrote:
"Skeptic" <bcs002b@yahoo.com> wrote in message
news:Sg6vj.42739$9j6.31268@attbi_s22...

I don't see that. Substandard care can result in medical
complications.
Medical complications are costly to fix and can be devastating to a
physician's credibiltiy. A commonly used example is the
gastroenterologist
perforating a colon and making money on the surgical repair. People
that
make those sorts of claims simply do not understand that the doctor
repairing the colon will be a busy general surgeon who was not
involved
in
the case and now has to cancel his clinic or come in in the middle of
the
night for an urgent surgery. The GI doc who perforated gets nothing
except
scrutiny.

This happened to our departmental secretary. She was a lady who
weighted exactly the ideal weight for her height, and after the
surgery
to
repair the perforation, looked 5-6 months pregnant for about 1 year.
She
lost 6 weeks of work, and got billed about $35,000 for the "repair."
Errors
are highly profitable to the system.

NB, the "system" here includes more than the two MDs listed,
although (like quarterbacks) they're the ones who get the
attention. Whether the MD who was on watch for the original
problem was the one who ended up submitting a bill for the
repair or not, and regardless of "blame," the /hospital/
takes incidents like this as revenue.

Now look at the list of items headed for noncompensation and
appreciate that a lot of them are in the "team effort" group.
Sponge miscounts, for instance. "Command responsibility" or
not, it is _not_ the surgeon who is supposed to be keeping
personal track of each sponge, and if I ever find out that
a surgeon planning to work on me /does/, I'm getting someone
else -- I want his attention on other things.

Instead, that sponge count is (IIRC) the responsibility of
an OR nurse who may well be working on her 12th hour on her
feet in a schedule that has her working both night and day
shifts (cost cutting, remember) and regardless of overtime
regs she hasn't had 24 hours straight off for six days.
Which might not be so bad except as another cost-cutting
measure the staffing has been cut back so that her workload
is more than she normally could keep track of anyway even
if she hadn't missed lunchbreak to catch up on paperwork and
is running low on blood sugar.

Hey, it saves on health care costs, right?

So keep in mind that since individual patients simply don't
have any negotiating power, and since the cost of running
a Board of Inquiry on every adverse outcome is prohibitive,
it may well be that pushing the cost of (at least some)
nonquality onto the caregivers *may* be the best shot that
MDs have for getting adequate support -- who aren't dead
on their feet.

The patient never knows who is responsible and will never be able to
find
out. But the bill must be paid in all cases, and insurance companies
have
no problem paying for errors. And hospitals have little incentive for
lowering error rates as long as it results in more profitable business.

Oh, come on - if your colon is perforated you know exactly was
responsible. Should that doctor be forced to cover the ensuing hospital
expenses? Of course not.

"George Conklin" <nil@earthlink.net> wrote in message
news:13rs71j4tt7qibc@corp.supernews.com...

"D. C. Sessions" <dcs@lumbercartel.com> wrote in message
news:9qa195-n3h.ln1@news.lumbercartel.com...
In message <13rrsrii43e7qf5@corp.supernews.com>, George Conklin wrote:
"Skeptic" <bcs002b@yahoo.com> wrote in message
news:Sg6vj.42739$9j6.31268@attbi_s22...

I don't see that. Substandard care can result in medical
complications.
Medical complications are costly to fix and can be devastating to a
physician's credibiltiy. A commonly used example is the
gastroenterologist
perforating a colon and making money on the surgical repair. People
that
make those sorts of claims simply do not understand that the doctor
repairing the colon will be a busy general surgeon who was not
involved
in
the case and now has to cancel his clinic or come in in the middle
of
the
night for an urgent surgery. The GI doc who perforated gets nothing
except
scrutiny.

This happened to our departmental secretary. She was a lady who
weighted exactly the ideal weight for her height, and after the
surgery
to
repair the perforation, looked 5-6 months pregnant for about 1 year.
She
lost 6 weeks of work, and got billed about $35,000 for the "repair."
Errors
are highly profitable to the system.

NB, the "system" here includes more than the two MDs listed,
although (like quarterbacks) they're the ones who get the
attention. Whether the MD who was on watch for the original
problem was the one who ended up submitting a bill for the
repair or not, and regardless of "blame," the /hospital/
takes incidents like this as revenue.

Now look at the list of items headed for noncompensation and
appreciate that a lot of them are in the "team effort" group.
Sponge miscounts, for instance. "Command responsibility" or
not, it is _not_ the surgeon who is supposed to be keeping
personal track of each sponge, and if I ever find out that
a surgeon planning to work on me /does/, I'm getting someone
else -- I want his attention on other things.

Instead, that sponge count is (IIRC) the responsibility of
an OR nurse who may well be working on her 12th hour on her
feet in a schedule that has her working both night and day
shifts (cost cutting, remember) and regardless of overtime
regs she hasn't had 24 hours straight off for six days.
Which might not be so bad except as another cost-cutting
measure the staffing has been cut back so that her workload
is more than she normally could keep track of anyway even
if she hadn't missed lunchbreak to catch up on paperwork and
is running low on blood sugar.

Hey, it saves on health care costs, right?

So keep in mind that since individual patients simply don't
have any negotiating power, and since the cost of running
a Board of Inquiry on every adverse outcome is prohibitive,
it may well be that pushing the cost of (at least some)
nonquality onto the caregivers *may* be the best shot that
MDs have for getting adequate support -- who aren't dead
on their feet.

The patient never knows who is responsible and will never be able to
find
out. But the bill must be paid in all cases, and insurance companies
have
no problem paying for errors. And hospitals have little incentive for
lowering error rates as long as it results in more profitable business.

Oh, come on - if your colon is perforated you know exactly was
responsible.
Should that doctor be forced to cover the ensuing hospital expenses? Of
course not.

"Skeptic" <bcs002b@yahoo.com> wrote in message
news:44Avj.44787$9j6.36928@attbi_s22...

"George Conklin" <nil@earthlink.net> wrote in message
news:13rs71j4tt7qibc@corp.supernews.com...

"D. C. Sessions" <dcs@lumbercartel.com> wrote in message
news:9qa195-n3h.ln1@news.lumbercartel.com...
In message <13rrsrii43e7qf5@corp.supernews.com>, George Conklin wrote:
"Skeptic" <bcs002b@yahoo.com> wrote in message
news:Sg6vj.42739$9j6.31268@attbi_s22...

I don't see that. Substandard care can result in medical
complications.
Medical complications are costly to fix and can be devastating to a
physician's credibiltiy. A commonly used example is the
gastroenterologist
perforating a colon and making money on the surgical repair.
People
that
make those sorts of claims simply do not understand that the doctor
repairing the colon will be a busy general surgeon who was not
involved
in
the case and now has to cancel his clinic or come in in the middle
of
the
night for an urgent surgery. The GI doc who perforated gets
nothing
except
scrutiny.

This happened to our departmental secretary. She was a lady who
weighted exactly the ideal weight for her height, and after the
surgery
to
repair the perforation, looked 5-6 months pregnant for about 1 year.
She
lost 6 weeks of work, and got billed about $35,000 for the "repair."
Errors
are highly profitable to the system.

NB, the "system" here includes more than the two MDs listed,
although (like quarterbacks) they're the ones who get the
attention. Whether the MD who was on watch for the original
problem was the one who ended up submitting a bill for the
repair or not, and regardless of "blame," the /hospital/
takes incidents like this as revenue.

Now look at the list of items headed for noncompensation and
appreciate that a lot of them are in the "team effort" group.
Sponge miscounts, for instance. "Command responsibility" or
not, it is _not_ the surgeon who is supposed to be keeping
personal track of each sponge, and if I ever find out that
a surgeon planning to work on me /does/, I'm getting someone
else -- I want his attention on other things.

Instead, that sponge count is (IIRC) the responsibility of
an OR nurse who may well be working on her 12th hour on her
feet in a schedule that has her working both night and day
shifts (cost cutting, remember) and regardless of overtime
regs she hasn't had 24 hours straight off for six days.
Which might not be so bad except as another cost-cutting
measure the staffing has been cut back so that her workload
is more than she normally could keep track of anyway even
if she hadn't missed lunchbreak to catch up on paperwork and
is running low on blood sugar.

Hey, it saves on health care costs, right?

So keep in mind that since individual patients simply don't
have any negotiating power, and since the cost of running
a Board of Inquiry on every adverse outcome is prohibitive,
it may well be that pushing the cost of (at least some)
nonquality onto the caregivers *may* be the best shot that
MDs have for getting adequate support -- who aren't dead
on their feet.

The patient never knows who is responsible and will never be able to
find
out. But the bill must be paid in all cases, and insurance companies
have
no problem paying for errors. And hospitals have little incentive for
lowering error rates as long as it results in more profitable business.

Oh, come on - if your colon is perforated you know exactly was
responsible. Should that doctor be forced to cover the ensuing hospital
expenses? Of course not.


it is called the "risks" of the procedure...which are explained thoroughly
to the patient...he signs an "informed consent" attesting to the fact
that
he accepts the risk (the risk at the bottom of the list...btw is "death")

perforation of the colon does not imply bad technique or even
malpractice....it happens(having been in more than my share of GI labs)

"George Conklin" <nil@earthlink.net> wrote in message
news:13rrsrii43e7qf5@corp.supernews.com...

"Skeptic" <bcs002b@yahoo.com> wrote in message
news:Sg6vj.42739$9j6.31268@attbi_s22...

"D. C. Sessions" <dcs@lumbercartel.com> wrote in message
news:jkpt85-1oi.ln1@news.lumbercartel.com...
In message <xMMuj.41516$yE1.27616@attbi_s21>, Skeptic wrote:
"Ilena Rose" <BIA@mundo.com> wrote in message
news:e02mr31mvnkggh68o0rjdra44sde0phlnm@4ax.com...

WASHINGTON - It's a new way to push for patient safety: Don't pay
hospitals for their errors.

Beginning Oct. 1, Medicare no longer will cover extra-care costs
for
eight preventable hospital errors. Nor can hospitals bill the
injured
patient for those extra costs.

"Money talks," says Dr. Steven Gordon, infectious disease chief at
the
Cleveland Clinic Foundation. "Every hospital CFO, this gets their
attention."

- - -

Medicare's targets

*Urinary tract infections from catheters

This is old news. This is also one of the biggest reasons we should
be
very
fearful of a government run healthcare system. UTI's are an
absolutely
unavoidable outcome in a percentage of patients with catheters in
place.
The people that come up with this insanity simply don't have a clue.

Is it possible to prevent every last single catheter infection?
(Aside from never using catheters, anyway) No, of course not.
Is the alternative to give care providers carte blanche to be
paid for bad patient outcomes regardless of substandard care?
One would hope not. Is the alternative to require the equivalent
of a Board of Inquiry on every nosocomial infection? Not cost-
effective.

If we take all of this out of the "blame" space and put it in
a "quality improvement" space, though, you get a different
perspective. The current incentive structure, frankly, is a
"cost plus" system where providers have a financial incentive
to provide substandard care which, when it causes adverse
patient outcomes, *increases* their revenues.

I don't see that. Substandard care can result in medical
complications.
Medical complications are costly to fix and can be devastating to a
physician's credibiltiy. A commonly used example is the
gastroenterologist
perforating a colon and making money on the surgical repair. People
that
make those sorts of claims simply do not understand that the doctor
repairing the colon will be a busy general surgeon who was not involved
in
the case and now has to cancel his clinic or come in in the middle of
the
night for an urgent surgery. The GI doc who perforated gets nothing
except
scrutiny.

This happened to our departmental secretary. She was a lady who
weighted exactly the ideal weight for her height, and after the surgery
to
repair the perforation, looked 5-6 months pregnant for about 1 year.
She
lost 6 weeks of work, and got billed about $35,000 for the "repair."
Errors
are highly profitable to the system.

But not to the people who make them.


The system is what supports the current practices and no one is going to

Note from Health Lover, Ilena Rosenthal:http://ilenarose.blogspot.com
A seemingly good idea with some very serious downsides!

Patients could be left ill or injured and not cared for ...

Caution!

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Medicare will not pay if hospital errs

February 19, 2008

WASHINGTON - It's a new way to push for patient safety: Don't pay
hospitals for their errors.

Beginning Oct. 1, Medicare no longer will cover extra-care costs for
eight preventable hospital errors. Nor can hospitals bill the injured
patient for those extra costs.

"Money talks," says Dr. Steven Gordon, infectious disease chief at the
Cleveland Clinic Foundation. "Every hospital CFO, this gets their
attention."

- - -

Medicare's targets

*Urinary tract infections from catheters

*Bloodstream infections from using catheters

*Falls

*Bed sores, or pressure ulcers

*Objects left in a patient during surgery

*Blood incompatibility, giving a dangerously wrong blood type

*An infection after heart surgery called mediastinitis

*Air embolism, an air bubble in a blood vessel

----------

Page compiled from Tribune reporter Jon Hilkevitch and Tribune news
services

"Skeptic" <bcs002b@yahoo.com> wrote in message
news:44Avj.44787$9j6.36928@attbi_s22...

"George Conklin" <nil@earthlink.net> wrote in message
news:13rs71j4tt7qibc@corp.supernews.com...

"D. C. Sessions" <dcs@lumbercartel.com> wrote in message
news:9qa195-n3h.ln1@news.lumbercartel.com...
In message <13rrsrii43e7qf5@corp.supernews.com>, George Conklin wrote:
"Skeptic" <bcs002b@yahoo.com> wrote in message
news:Sg6vj.42739$9j6.31268@attbi_s22...

I don't see that. Substandard care can result in medical
complications.
Medical complications are costly to fix and can be devastating to a
physician's credibiltiy. A commonly used example is the
gastroenterologist
perforating a colon and making money on the surgical repair.
People
that
make those sorts of claims simply do not understand that the doctor
repairing the colon will be a busy general surgeon who was not
involved
in
the case and now has to cancel his clinic or come in in the middle
of
the
night for an urgent surgery. The GI doc who perforated gets
nothing
except
scrutiny.

This happened to our departmental secretary. She was a lady who
weighted exactly the ideal weight for her height, and after the
surgery
to
repair the perforation, looked 5-6 months pregnant for about 1 year.
She
lost 6 weeks of work, and got billed about $35,000 for the "repair."
Errors
are highly profitable to the system.

NB, the "system" here includes more than the two MDs listed,
although (like quarterbacks) they're the ones who get the
attention. Whether the MD who was on watch for the original
problem was the one who ended up submitting a bill for the
repair or not, and regardless of "blame," the /hospital/
takes incidents like this as revenue.

Now look at the list of items headed for noncompensation and
appreciate that a lot of them are in the "team effort" group.
Sponge miscounts, for instance. "Command responsibility" or
not, it is _not_ the surgeon who is supposed to be keeping
personal track of each sponge, and if I ever find out that
a surgeon planning to work on me /does/, I'm getting someone
else -- I want his attention on other things.

Instead, that sponge count is (IIRC) the responsibility of
an OR nurse who may well be working on her 12th hour on her
feet in a schedule that has her working both night and day
shifts (cost cutting, remember) and regardless of overtime
regs she hasn't had 24 hours straight off for six days.
Which might not be so bad except as another cost-cutting
measure the staffing has been cut back so that her workload
is more than she normally could keep track of anyway even
if she hadn't missed lunchbreak to catch up on paperwork and
is running low on blood sugar.

Hey, it saves on health care costs, right?

So keep in mind that since individual patients simply don't
have any negotiating power, and since the cost of running
a Board of Inquiry on every adverse outcome is prohibitive,
it may well be that pushing the cost of (at least some)
nonquality onto the caregivers *may* be the best shot that
MDs have for getting adequate support -- who aren't dead
on their feet.

The patient never knows who is responsible and will never be able to
find
out. But the bill must be paid in all cases, and insurance companies
have
no problem paying for errors. And hospitals have little incentive for
lowering error rates as long as it results in more profitable business.

Oh, come on - if your colon is perforated you know exactly was
responsible.
Should that doctor be forced to cover the ensuing hospital expenses? Of
course not.

Of course not? Fixing errors is part of the cost of doing business in
all other fields. If the mechanic ruins your car, the dealer's insurance
from the dealer covers that. If a doctor ruptures a colon, he states
he/she
is not responsible but you are. Medicine is still based on the
small-business model of 1900, but there used to be personal responsibility
what went with that model.

Hawki63@sbcglobal.net> wrote in message
news:6LDvj.5639$Mw.2523@nlpi068.nbdc.sbc.com...

"Skeptic" <bcs002b@yahoo.com> wrote in message
news:44Avj.44787$9j6.36928@attbi_s22...

"George Conklin" <nil@earthlink.net> wrote in message
news:13rs71j4tt7qibc@corp.supernews.com...

"D. C. Sessions" <dcs@lumbercartel.com> wrote in message
news:9qa195-n3h.ln1@news.lumbercartel.com...
In message <13rrsrii43e7qf5@corp.supernews.com>, George Conklin
wrote:
"Skeptic" <bcs002b@yahoo.com> wrote in message
news:Sg6vj.42739$9j6.31268@attbi_s22...

I don't see that. Substandard care can result in medical
complications.
Medical complications are costly to fix and can be devastating to
a
physician's credibiltiy. A commonly used example is the
gastroenterologist
perforating a colon and making money on the surgical repair.
People
that
make those sorts of claims simply do not understand that the
doctor
repairing the colon will be a busy general surgeon who was not
involved
in
the case and now has to cancel his clinic or come in in the middle
of
the
night for an urgent surgery. The GI doc who perforated gets
nothing
except
scrutiny.

This happened to our departmental secretary. She was a lady
who
weighted exactly the ideal weight for her height, and after the
surgery
to
repair the perforation, looked 5-6 months pregnant for about 1
year.
She
lost 6 weeks of work, and got billed about $35,000 for the
"repair."
Errors
are highly profitable to the system.

NB, the "system" here includes more than the two MDs listed,
although (like quarterbacks) they're the ones who get the
attention. Whether the MD who was on watch for the original
problem was the one who ended up submitting a bill for the
repair or not, and regardless of "blame," the /hospital/
takes incidents like this as revenue.

Now look at the list of items headed for noncompensation and
appreciate that a lot of them are in the "team effort" group.
Sponge miscounts, for instance. "Command responsibility" or
not, it is _not_ the surgeon who is supposed to be keeping
personal track of each sponge, and if I ever find out that
a surgeon planning to work on me /does/, I'm getting someone
else -- I want his attention on other things.

Instead, that sponge count is (IIRC) the responsibility of
an OR nurse who may well be working on her 12th hour on her
feet in a schedule that has her working both night and day
shifts (cost cutting, remember) and regardless of overtime
regs she hasn't had 24 hours straight off for six days.
Which might not be so bad except as another cost-cutting
measure the staffing has been cut back so that her workload
is more than she normally could keep track of anyway even
if she hadn't missed lunchbreak to catch up on paperwork and
is running low on blood sugar.

Hey, it saves on health care costs, right?

So keep in mind that since individual patients simply don't
have any negotiating power, and since the cost of running
a Board of Inquiry on every adverse outcome is prohibitive,
it may well be that pushing the cost of (at least some)
nonquality onto the caregivers *may* be the best shot that
MDs have for getting adequate support -- who aren't dead
on their feet.

The patient never knows who is responsible and will never be able to
find
out. But the bill must be paid in all cases, and insurance companies
have
no problem paying for errors. And hospitals have little incentive for
lowering error rates as long as it results in more profitable
business.

Oh, come on - if your colon is perforated you know exactly was
responsible. Should that doctor be forced to cover the ensuing hospital
expenses? Of course not.


it is called the "risks" of the procedure...which are explained
thoroughly
to the patient...he signs an "informed consent" attesting to the fact
that
he accepts the risk (the risk at the bottom of the list...btw is "death")

perforation of the colon does not imply bad technique or even
malpractice....it happens(having been in more than my share of GI labs)

All those relase forms say is that anything that we do that harms you is
your own personal fault and no one is responsible. Act of God.

"Skeptic" <bcs002b@yahoo.com> wrote in message
news:y2Avj.45039$yE1.35563@attbi_s21...

"George Conklin" <nil@earthlink.net> wrote in message
news:13rrsrii43e7qf5@corp.supernews.com...

"Skeptic" <bcs002b@yahoo.com> wrote in message
news:Sg6vj.42739$9j6.31268@attbi_s22...

"D. C. Sessions" <dcs@lumbercartel.com> wrote in message
news:jkpt85-1oi.ln1@news.lumbercartel.com...
In message <xMMuj.41516$yE1.27616@attbi_s21>, Skeptic wrote:
"Ilena Rose" <BIA@mundo.com> wrote in message
news:e02mr31mvnkggh68o0rjdra44sde0phlnm@4ax.com...

WASHINGTON - It's a new way to push for patient safety: Don't pay
hospitals for their errors.

Beginning Oct. 1, Medicare no longer will cover extra-care costs
for
eight preventable hospital errors. Nor can hospitals bill the
injured
patient for those extra costs.

"Money talks," says Dr. Steven Gordon, infectious disease chief at
the
Cleveland Clinic Foundation. "Every hospital CFO, this gets their
attention."

- - -

Medicare's targets

*Urinary tract infections from catheters

This is old news. This is also one of the biggest reasons we
should
be
very
fearful of a government run healthcare system. UTI's are an
absolutely
unavoidable outcome in a percentage of patients with catheters in
place.
The people that come up with this insanity simply don't have a
clue.

Is it possible to prevent every last single catheter infection?
(Aside from never using catheters, anyway) No, of course not.
Is the alternative to give care providers carte blanche to be
paid for bad patient outcomes regardless of substandard care?
One would hope not. Is the alternative to require the equivalent
of a Board of Inquiry on every nosocomial infection? Not cost-
effective.

If we take all of this out of the "blame" space and put it in
a "quality improvement" space, though, you get a different
perspective. The current incentive structure, frankly, is a
"cost plus" system where providers have a financial incentive
to provide substandard care which, when it causes adverse
patient outcomes, *increases* their revenues.

I don't see that. Substandard care can result in medical
complications.
Medical complications are costly to fix and can be devastating to a
physician's credibiltiy. A commonly used example is the
gastroenterologist
perforating a colon and making money on the surgical repair. People
that
make those sorts of claims simply do not understand that the doctor
repairing the colon will be a busy general surgeon who was not
involved
in
the case and now has to cancel his clinic or come in in the middle of
the
night for an urgent surgery. The GI doc who perforated gets nothing
except
scrutiny.

This happened to our departmental secretary. She was a lady who
weighted exactly the ideal weight for her height, and after the surgery
to
repair the perforation, looked 5-6 months pregnant for about 1 year.
She
lost 6 weeks of work, and got billed about $35,000 for the "repair."
Errors
are highly profitable to the system.

But not to the people who make them.


The system is what supports the current practices and no one is going
to
criticize a physician who gives them a lot of profitable referrals.

Hawki63@sbcglobal.net> wrote in message
news:6LDvj.5639$Mw.2523@nlpi068.nbdc.sbc.com...

it is called the "risks" of the procedure...which are explained thoroughly
to the patient...he signs an "informed consent" attesting to the fact that
he accepts the risk (the risk at the bottom of the list...btw is "death")

perforation of the colon does not imply bad technique or even
malpractice....it happens(having been in more than my share of GI labs)

All those relase forms say is that anything that we do that harms you is
your own personal fault and no one is responsible. Act of God. You pay.
Public policy which pushes everyone in the nation to have these tests (even
without symptoms) simply accepts the idea that a certain percentage will die
but who cares? Not the policy boys.