It's time to stop rewarding hospital errors with cash flow

Occasionally I reference television shows to discuss patterns of healthcare delivery. One that currently comes to mind is the CBS drama Chicago Hope, which ran during the second half of the 1990s.

A dark comedy of errors took place within the show's title character. There was the heart transplant patient who died after the organ he was to receive was dropped to the floor and skidded behind some machinery. There was the patient admitted for abusing amyl nitrates who wound up on the business end of a variety of mishaps, including being dropped on his head (which led to emergency brain surgery). Those were just in the first dozen episodes of the show's run.

The collateral effect on that fictional hospital's bottom line wasn't discussed, but I'm sure on television its management would have refused to accept payment for such bungles. A real life Chicago Hope Medical Center would have made out like a bandit.

Nearly 20 years after those episodes aired on television, the actual effort to stanch errors in care, hospital-acquired infections and other medical-made mishaps is proceeding unevenly at best. While the Medicare program has begun withholding payments to providers when patients are re-hospitalized, acute care providers still continue to make a lot of money from messes of their own making. A study released last month by the Journal of the American Medical Association found hospitals reaped an average additional payment of $39,000 from private insurers when surgeries were complicated by errors, and $1,700 from Medicare. 

And a study released by Johns Hopkins University researchers just a few days ago concluded that hospitals received a staggering $400,000 for each case of central line-associated bloodstream infections (CLABSI) they treat. That's despite the fact CLABSI is purely a hospital-acquired event.

One of the authors of this study, Peter Pronovost, M.D., pioneered a straightforward, checklist-oriented process for inserting central lines that dramatically reduces infection rates, and can often eliminate it completely. Hospitals in states such as Michigan that introduced the protocol en masse reduced CLABSI to an outlier event. 

Yet the Pronovost protocol is not standard for hospitals across the country. Cultural resistance is part of the reason. This was borne out in an interview I had a few years ago with the head of an infection control program at a major Los Angeles-area hospital. This highly articulate individual with a doctorate in public health shared his enormous exasperation with getting his equally well-educated colleagues to listen to his ideas. When they were finally implemented, the hospital began saving more than $1 million a year. But even introducing new ideas at that hospital led to continued pushback.

I also have to believe that for some hospitals, the bottom line may be a consideration as well. Not as an act of commission; no one is deliberately engaging in a CLABSI for dollars scheme. Instead, it is an act of omission--the "what's in it for the bottom line?" ethos that drives the cost-center versus profit-center evaluations behind running hospitals and other large-scale business.

Private insurers have been grumbling for years that the mergers among hospitals have eroded their leverage in contract negotiations. Focusing on the costs behind errors and hospital-acquired infections is a way to rebuild their leverage while helping out the people they insure.

Chicago Hope's comedy of errors ended after five-and-a-half years, the logical course for a middling television show with decent ratings. However, the actual comedy of errors has gone on in real-life hospitals for decades, with little motivation to end its run.

It's long past due for a cancellation.  - Ron (@FierceHealth)

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