Medical Errors

You know those signs in gift shops, "You break, You pay?" Medicare has adopted that philosophy in refusing to pay hospitals for "never events"—things that just shouldn't happen to patients. Now the agency has proposed adding to its list.

Last year Medicare announced it would not pay for certain medical errors and conditions acquired in hospitals. Starting October 1, several private insurers followed suit. Now Medicare wants to add nine more avoidable conditions and complications, if acquired in the hospital. The goal, which we like, is to put some financial teeth in efforts to improve care of patients, including infection control. Hospitals should not be dangerous to our health.

According to the AP, the new list includes deep vein thrombosis, or a blood clot within the vascular system, which occurred in 140,010 cases for the fiscal year ending September 30, ventilator-associated pneumonia, which occurred in 30,867 cases, bloodstream infections with the staph aureus bacteria, 27,737 cases, and Legionnaire's disease, which occurred in 351 cases.

One pill, two pills? Red pills, blue pills? Each year  more than 1.5 million people are injured by preventable medication errors, and, according to a new study in Pediatrics reported by the Associated Press, about one out of every 15 hospitalized children is harmed by a medication error--getting the wrong drug, the wrong dosage, or the wrong reaction.

We wrote about medication errors recently after actor Dennis Quaid related his baby twins'  ordeal to the  Association of Health Care Journalism conference last month. Quaid is using his celebrity to draw attention to practical ways of reducing medical errors. His newborns nearly died last November after receiving the wrong dosage of the blood thinner Heparin.

Reducing medical errors is an important goal in itself—the Institute of Medicine estimates that as many as 98,000 Americans die each year because of preventable mistakes. But that goal will be most effectively achieved as part of a comprehensive reform which would combine and amplify the incentives for developing health information systems, changing payment incentives and sharing best-practices among all clinicians.

"Oops I did it again," may have made millions as a pop song, but for 11 preventable medical errors, it will no longer get you paid by the Indianapolis-based insurer, WellPoint, according to an article in today's Indianapolis Star.

WellPoint joins a growing number of public and private payers in efforts aimed at promoting quality, reducing errors, and controlling costs in our medical system. WellPoint's new policy adopts the steps taken by the Centers for Medicare and Medicaid Services last fall to no longer pay for preventable medical errors, injuries and infections that occur in hospitals.

Like CMS, WellPoint will make sure that neither it nor its patients pay for three so-called "never events"—surgical mistakes that should never happen under any circumstances. They are:

• Surgery on the wrong body part
• Surgery on the wrong patient
• The wrong surgery performed on a patient.

Additionally the insurer will limit payments for the following events, all of which are highly preventable when evidenced-based guidelines are adhered to:

Imagine if your newborn twins, already hospitalized with an infection likely acquired at another hospital, were given two potentially fatal overdoses of a blood thinner. Imagine if your pediatrician (now your former pediatrician) did not call to tell you. Imagine if the night nurse told you everything was fine when you phoned to check on the babies. Imagine if you learned the truth when you arrived at the hospital at 6 a.m. to see your kids and were met by Risk Management.

That's what happened to Dennis Quaid last winter. His babies survived. His story has been told. But Quaid hasn't forgotten the 41-hour ordeal, when his tiny children nearly bled to death, their blood "squirting on the walls." He has joined the ranks of "cause celebrities," knowing that his fame can bring national attention to medical errors that usually occur in isolation. He has set up a new foundation to address patient safety, particularly regarding medication errors.

Remember that scary Institute of Medicine report a few years back about the 98,000 fatal medical errors in hospitals each year? And the conclusion that it wasn't the fault of a few "bad apple" or incompetent doctors and nurses, but layers of unnecessary hazards built into the system? The problems range from confusing packaging to the "hurry up and rush" culture of hospitals. Today's Wall Street Journal has an interesting article on how hospitals are rethinking how they use the riskiest drugs--the eight medications which studies have shown account for nearly one-third of the drug errors that harm patients.