What If Insurers Stop Paying for Hospitals' Mistakes?

  • With healthcare ranking as one of this election year's top issues, we're bound to see many stories of interest for those of us caring for elders (or with health issues of our own). Here's one of the latest. From The Wall Street Journal comes a story titled "Insurers Stop Paying for Care Linked to Errors: Health Plans Say New Rules Improve Safety and Cut Costs; Hospitals Can't Dun Patients."


    According to the story, Medicare announced last summer that starting this October they will refuse to pay hospitals for medical procedures done in error, such as an operation done on the wrong arm or leg of a patient. They also will not pay for treating bed sores, effects of falls and some other preventable injuries and infections that afflict a hospitalized patient. In 2009, they will add more items to the list.

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    The patients are not to be billed for these procedures, either. The hospital must swallow the cost.


    Now, insurance companies are looking at doing the same thing. According to the article, both Medicare and insurers say that this refusal to pay for errors will result in better and safer care for the patient and lower insurance premiums. We can hope this is true, but most of us know that somehow the patient will pay, whether through higher hospital costs or some other means.


    What frightens me is that there will be more bills that patients don't understand with more language and numbers that are meaningless to the average consumer. Medicare tells people that they need to watch their hospital bills carefully. It's hard enough to decipher a bill from the local clinic after a checkup. A hospital bill is nearly incomprehensible. And consumers may end up unknowingly paying (or trying to pay) what the insurers refuse to pay.


    Also, I am concerned about where the proof lies. If my elder gets a bladder infection in the hospital due to what I consider poor care, do I need to prove that it was due to poor care? Will the average consumer be intimidated into paying for the errors insurance won't pay for because they don't have the money to hire an expert to prove that the hospital was at fault?


    The idea is good. Don't pay the hospital for making mistakes or for poor infection control. The hospital knows it will lose money so it will literally "clean up its act." Everyone wins.


    One can hope. I don't mean to be cynical, but my guess is we, the consumers, will pay for these mistakes, one way or the other. And we also may have to hire a professional to decipher our bills. Yet, Medicare and insurers are right that hospitals are making too many mistakes and that too many are skipping steps in infection control.


    So, maybe this is progress. Proof of success or failure will not be available, perhaps for years. Will there be fewer mistakes? Or will consumers just have to cough up more money? Let's hope too many unwary consumers don't get burned while this all shakes out.


    To learn more about Carol, please go to www.mindingourelders.com or www.mindingoureldersblogs.com.

Published On: January 15, 2008