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Elizabeth Cooney is a health reporter for the Worcester Telegram & Gazette.
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Monday, August 20, 2007

Patient safety leader applauds Medicare policy to not pay for hospital errors

By Elizabeth Cooney, Globe Correspondent

A leader of the patient safety movement supports Medicareís decision to not cover hospitals' costs of treating preventable errors, saying itís time to go beyond altruistic efforts at improving outcomes.

"I would have preferred it to have been positive rather than punitive, but the time has passed for that, Iím afraid," Dr. Lucian Leape of the Harvard School of Public Health said in an interview. "Weíve got a lot of solutions out there and the thing that is so frustrating is they havenít been implemented."

Under the new regulations, Medicare will not pay the costs of treating patients harmed by errors, injuries and infections that occur in hospitals.

The list of conditions includes pressure ulcers (bedsores), injuries from falls, and infections, most commonly from the use of catheters in the bladder or lines inserted into blood vessels. Hospital-acquired infections lead to 99,000 deaths a year, according to an estimate by the US Centers for Disease Control and Prevention.

Leape was an author of the landmark Institute of Medicine report "To Err is Human" in 1998 that said as many as 98,000 people die each year from hospital medical errors. Since that time, the picture has improved, he said -- citing the Cambridge-based Institute for Healthcare Improvement's "100,000 Lives Saved" campaign -- but not enough.

"That progress has been made in the absence of any financial incentives or penalties," he said. "It has been done because a lot of good people Ė- doctors, nurses, administrators and others -Ė have wanted to do the right thing and reduce injuries. That just hasnít been enough, so people are beginning to pull the other lever, pulling the financial incentives in."

The Medicare move wasnít a surprise to hospitals, Karen Nelson, vice president of clinical affairs at the Massachusetts Hospital Association, said in an interview, calling it consistent with a trend toward pay for performance and public reporting of patient outcomes.

"This is sort of the flip side: non-payment for non-performance," she said. "The new angle to this is an implied causation. We hope that the final rules that come out are clear and easy for hospitals to apply in terms of documenting, to ensure that the attribution is correct."

That might mean getting urine samples before a patient is admitted to determine whether a patient already has a urinary tract infection, she said, a practice in place now but not used for every patient.

John Auerbach, commissioner of the state Department of Public Health, applauded the Medicare policy, but said it was only one part of a solution that will also involve the state and individual hospitals.

"I think it's an excellent policy and we need a range of different approaches in terms of eliminating these infections and injuries," he said in an interview. "Reimbursement is one of them, providing technical assistance and education is another one, and requiring public reporting of these infections and injuries is a third. If we employ them all, it will end up being the best thing for the patient."

Posted by Elizabeth Cooney at 06:21 PM
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