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Medicare's Somewhat Faulty Attempt at Preventing Medical Malpractice

Mellino Law Firm

Back in 2012, Kaiser Health News reported that Medicare would begin rewarding hospitals that provided quality care to patients and reducing payments to those that didn’t.

“The Medicare program wants to ensure that the services they pay for are of high quality,” APTA stated.

As a result, Cleveland Clinic and 1,556 others were slated to receive bonuses, according to Kaiser’s December 20 article. Conversely, more than 2,200 hospitals were penalized because too many patients wound up readmitted within 30 days.

“The way the program works is that Medicare is reducing payments to all hospitals by 1 percent, estimated at $964 million. It then calculated a score on how much money each hospital deserved to get back based on the quality of its care. While every hospital is getting something back, almost half aren’t recouping the 1 percent they forfeited and thus are net losers,” the article stated.

Seventh percent of a hospital’s score is based on how well it adhered to 12 standards of care; the other 30 percent is based on patient surveys.

One study noted that “[b]igger hospitals, teaching hospitals and hospitals with the most poor patients tended to do worse than smaller hospitals, hospitals that don’t train residents and hospitals with a more affluent patient mix.”

In a follow-up September 30, 2014, Kaiser Health noted that Medicare’s bonus program excludes many rural acute-care hospitals. Ohio has 34 such facilities, but the article didn’t say how many were left out of the new policy. Four hundred exist across the country.

“Critically ill patients, sometimes unresponsive or in comas, may live here for months, even years, sustained by respirators and feeding tubes. Some, especially those recovering from accidents, eventually will leave. Others will be here for the rest of their lives,” NY Times said June 23, 2014. “… Medicare, concerned about the high price of long-term acute care hospitals, is trying to trim reimbursements.”

One doctor told nytimes.com that Medicare doesn’t know how to accurately measure quality patient care. Instead, it relies on standards that intensive care units use, and ICUs focus on one day at a time, not long-term recovery.

“It’s very unfortunate that critical access hospitals continue to be exempt from all the new policies aimed at improving quality and safety at hospitals in America,” Leapfrog Group CEO Leah Binder told Kaiser. “If you live in a rural community and you are dependent on a critical access hospital, the federal government has abandoned you.”

Why Should Medicare Play a Role in Preventing Medical Malpractice?

As William M. Sage wrote in 2006, “We need to turn a corner in medical malpractice policy. The old Clinton campaign mantra ‘It’s the economy, stupid’ can be restated for medical malpractice as ‘It’s patient care, stupid.’ For the most part, the malpractice reform debate has been about things outside of the health care system, such as lawyers, courts, or the supposed litigiousness of the American public. … [But] malpractice reform is fundamentally about resolving problems with medical care. … The solution is to integrate malpractice policy with health policy.”

Sage went on to suggest that Medicare’s role as the country’s largest insurance program could have a profound effect on medical errors and lawsuits.

“One approach that has gathered steam in recent months, both within Medicare and outside it, is ‘pay for performance,’ he said. “If avoidable injury is bad medicine, communicating poorly with patients and their families after injury is bad medicine, and not compensating patients fairly and promptly is bad medicine, then Medicare might pay physicians and hospitals for doing these things better.”

Unfortunately, as the Association of Health Care Journalists reported September 8, 2014, Medicare’s current way of doing things has many downsides. For instance, “Medicare and most health plans don’t pay physicians to respond to a patient phone call about a symptom or problem, even though those phone calls can avoid far more expensive visits to the emergency room,” a cited study stated.

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