A surgeon amputates the wrong foot or leaves a sponge sewn in your abdomen. You're given the wrong blood type. Bedsores. Infections. Falls. A missed asthma diagnosis.
Which events are intolerable, and which are merely unfortunate? Should hospitals and doctors be punished financially for mistakes, or should they be rewarded for getting it right?
Nationally, health care providers are debating those issues and installing their own systems to minimize mistakes and infections, even as a new report from the RAND Corp. says it's too early to tell whether these systems are improving the total quality of patient care.
With much left to study, here's one thing that everybody knows for sure: Errors large and small can cost insurers and hospitals financially, and worse, they can cost the patients their good health -- or their lives.
"When something very wrong happens," said Tami Merryman, University of Pittsburgh Medical Center's chief quality control officer, "we want to correct it."
In western Pennsylvania, for instance, most of the hospitals that do business with Highmark Inc., Pittsburgh's largest health insurer, participate in Highmark's QualityBlue program.
Among other things, the program aims to cut down on Methicillin Resistant Staphylococcus Aureus (MRSA) infections and central-line bloodstream infections, and reduce a number of other preventable events -- surgical site infections, blood clots, urinary tract infections, and so on.
In the industry, it's called pay-for-performance -- if hospitals and their doctors and nurses can improve infection rates, and document it, they are rewarded for it. Seven years ago, when Highmark's program got under way, only six hospitals participated. Today, the number is 36, covering 70 percent of Highmark's inpatient hospital claims in the western half of the state. With that many hospitals, and years of data under its belt, Highmark says its quality control measures are working.
Regarding central line infections, for instance, rates at participating hospitals continue to fall. In 2007, the simple act of reducing central line bloodstream infections, by following specific guidelines for inserting the lines and keeping things sanitary, may have saved the health system as much as $52 million and saved 375 lives.
The goal is to get hospitals to "identify gaps in the delivery of care, take their own steps in determining what was causing the gaps in care, implementing interventions and then re-measuring to see if the gaps are resolved," said Dr. Carey Vinson, vice president of quality and medical performance at Highmark.
Physicians, too, can be rewarded. With Highmark, doctors who get the insurer's highest quality score ranking (for encouraging mammograms, managing patients' cholesterol levels, diabetes screening, and so on), will bring their practices, say, a $9 bonus for each claim filed.
But the RAND study suggests that the bonuses weren't high enough to spur change among many practices. "Most of the medical groups surveyed suggested that the program's financial incentives -- generally about $1,500 to $2,000 annually per physician -- were too small to stimulate significant change among most doctors," the report said.
"A physician in Great Britain can earn between $30,000 and $50,000 a year in a performance bonuses each year," said Cheryl Damberg, the RAND study's lead author. But the concern is that "if you raise it too much, is that going to distort" how doctors go about doing their jobs.
E-mail Bill Toland at btoland(at)post-gazette.
(Distributed by Scripps Howard News Service, www.scrippsnews.com.)
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