Dangerous Hospitals and Medicare. (the Medicare Economist)

Article excerpt

President Bush is looking for ways to save money on Medicare to pay for prescription drug coverage. Here's a lifesaving way to do it: He should tell Medicare to insist on quality, and draw the line on paying hospitals with high infection rates and frequent medical errors.

Every single year, close to 100,000 people die from infections they get in the hospital. Medical errors--giving patients the wrong drug, the wrong dose, the wrong organ transplant, even operating on the wrong body part--take thousands more lives. The monetary cost is large, close to $30 billion a year in medical bills, based on data from the Harvard Medical Practices Study. The federal government pays 45 percent of that tab. These infections and medical errors are largely preventable. What's standing in the way of reducing them?

Astoundingly, Medicare. Medicare pays the same fees to hospitals with the best care as it does to those with high infection rates, numerous medical errors, and substandard survival rates. That indifference to quality puts patients at risk and pushes up health care costs. One serious bloodstream infection adds $35,000 to a hospital bill.

Some large employers and insurance companies are taking a new approach: They pay higher rates to hospitals that make lifesaving improvements. The Leapfrog Group, a coalition of large companies, pays a premium to hospitals that require physicians to enter prescriptions in a computerized system rather than scribbling them on a pad, for instance. This helps prevent medication mistakes.

These private-sector efforts can't succeed without Medicare. It alone has the market clout to make hospitals improve.

Unfortunately, Medicare does business with any hospital accredited by the Joint Council on the Accreditation of Health Care Organizations (JCAHO). How tough are JCAHO standards? They're "not likely to give you an idea of the safety and quality of hospitals," says Arthur Levin, director of the Center for Medical Consumers.

The problem is that JCAHO is funded by fees from the hospitals it accredits. Consequently, it doesn't ask questions that hospitals don't want to answer.

In general, JCAHO visits a hospital every three years, and provides several months advance notice. That gives the hospital time to hire consultants to help it pass. …