Over the past year, there have been hundreds of incidents of death or serious medical harm that were disclosed by hospitals in the Washington DC area, preventable errors that until recently have not required public reporting. Under laws that took effect last year in Virginia and a few years earlier in DC and Maryland, hospitals must report to health officials the many serious injuries that patients may suffer in the course of treatment. For example, in one case in DC, a patient was readmitted to the hospital complaining of serious leg pain after the surgeon operated on the wrong part of his spine.
While the public record in Virginia discloses the names of the hospitals involved, DC’s and Maryland’s do not. All three regions, however, give the American public a glimpse into the mistakes health experts call “never events”, because they should never happen: operations on the wrong body part, sponges being left in patients after surgery, and medication errors. At least twenty states require hospitals to report any incidence of hospital-acquired infection as well.
Patients, insurers and regulators are beginning to use this information to nudge health-care providers to ensure that such events never happen. In the past, insurance companies were billed when a doctor, nurse, or technician was responsible for injuring a patient; Maryland health regulators estimate that insurance companies paid $522 million last year to cover preventable complications in hospitals, which occurred in 55,000 of the state’s 800,000 inpatient cases. Now, however, many private and public insurers are following Medicare’s lead by refusing payment as a punishment to hospitals. They hope this act will encourage hospitals to make improvements in their system of care. For example, they will not pay for treating a urinary tract infection caused by a catheter.
In Maryland, the hospital association has agreed not to bill insurance companies for eight mistakes, such as transfusions using the wrong blood type and surgery on the wrong side. As part of a new initiative program, the state commission will begin ranking its hospitals on how often they commit fifty-two preventable mistakes; hospitals that commit the most mistakes will be required to bill insurers at a lower rate than hospitals who commit fewer mistakes. Fines will also be implemented as punishment for mistakes.
Additionally, the hospital association in Virginia has agreed not to bill insurance companies for several errors caused by hospital staff. Anthem Blue Cross and Blue Shield, Virginia’s largest private insurer, has stopped paying hospitals for four surgical mistakes: when the wrong body part is operated on; when the wrong procedure is done; when a foreign object is left in the patient requiring additional surgery, and when the wrong patient is operated on.
Finally, in DC, hospitals, nursing homes and clinics have reported 529 mistakes form July 2007 to June 2008; fourteen of these led to the death of a patient. So far, the District has tried not to use financial incentives to affect the hospitals’ behavior.