Harvard: surgical complications = 330% more profit

[Carol]

The study appears in the April 17, 2013 issue of the Journal of the American Medical Association (JAMA).

“We found clear evidence that reducing harm and improving quality is perversely penalized in our current health care system,” said Sunil Eappen, the lead author and chief medical officer of Massachusetts Eye and Ear Infirmary.

“It’s been known that hospitals are not rewarded for quality. But it hadn’t been recognized exactly how much more money they make when harm is done,” said senior author Atul Gawande, director of Ariadne Labs, professor in the Department of Health Policy and Management at HSPH and a surgeon at BWH.

Read More:
http://www.hsph.harvard.edu/news/pr...ions-provide-greater-hospital-profit-margins/

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[arnisador]

Ugh.

 

[Bob Hubbard]

But we fixed that right? Improving the quality of health care and lowering the costs were taken care of in 2010 and take effect in 2014 right? Oh wait, 30,000 page health law, and they missed this part. Funny thing that.

 

[ballen0351]

But do you think they purposely try to mess up to make more money? Or is it just a coincidence. I don't think docs and nurses would try to mess up or hurt people.

 

[Steve]

But do you think they purposely try to mess up to make more money? Or is it just a coincidence. I don't think docs and nurses would try to mess up or hurt people.

Hard to say. When you combine basic human needs with money, historically, the money wins out. Child labor, unsafe working conditions, you name it.

Here's a simple example that I know is true. Often, when you get your lipids checked, they will not tell you to fast for 24 hours. They wont lie if asked (because that would be unethical). they just... forget to volunteer it.

It is a simple, easy way to obtain skewed results so that you have to get an additional blood draw. The doctor gets two visits to bill, the staff charges two blood draws and the testing facilities get two, as a well.

Medicine is rife with this, because we insist that it should be for profit.


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[jks9199]

Hard to say. When you combine basic human needs with money, historically, the money wins out. Child labor, unsafe working conditions, you name it.

Here's a simple example that I know is true. Often, when you get your lipids checked, they will not tell you to fast for 24 hours. They wont lie if asked (because that would be unethical). they just... forget to volunteer it.

It is a simple, easy way to obtain skewed results so that you have to get an additional blood draw. The doctor gets two visits to bill, the staff charges two blood draws and the testing facilities get two, as a well.

Medicine is rife with this, because we insist that it should be for profit.


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Never had a case where the doc or his office had to repeat a test because they didn't tell me to fast. I can only think of one or two times where a second draw was necessary, and those were to confirm or see trends.

I just ended up having back surgery. I can sit here with 20/20 hindsight, and say they could have skipped the x-ray and gone straight to the MRI, which would have revealed the ruptured disc immediately. So, maybe a little savings there. The surgery was supposed to be outpatient -- but I ended up having to stay overnight because of my reaction to the anesthesia. Did I really need to stay? Probably not... but since it was about me not breathing, I kind of appreciate that they erred on the side of caution, y'know? Did the anesthesiologist decide to pad the bill for the hospital by keeping me overnight? I doubt it.

Yes, the profit model combined with the current malpractice industry encourages spending money unnecessarily. But I don't see inherent evil.

 

[billc]

The fear of a malpractice law suit is probably more to blame than anything else. Just look at how much a doctor pays in malpractice insurance, off the top, before he can earn any money. when a wrong diagnosis, or simple mistake can destroy about 10 years of effort to become a doctor...they get a little nervous about making mistakes...

 

[Scott T]

But do you think they purposely try to mess up to make more money? Or is it just a coincidence. I don't think docs and nurses would try to mess up or hurt people.

Unless they're more interested in personal enrichment than actual care, or under pressure by hospital administration to bring in the money.

 

[ballen0351]

I've never had a doc not tell me to fast I've always gotten a paper with all the instruction printed on it of what to eat when to stop eating etc. I don't know I've always thought my docs did the best job they could. I think the article kinda states the obvious here. If they mess up that will require extra treatment which in turn costs extra money. Simple math really more work = more cost.

 

[ballen0351]

Damn where do you people live do you guys trust anyone? You don't trust the police you don't trust docs you don't trust the Govt you don't trust schools or churches or hospital or the military. I'm a pretty cynical guy but damn

 

[billc]

I would like to see exactly what they mean by surgical complications, that would clarify this a lot more. A surgical complication also brings in greater risk of law suits which is an insentive to not have complications since a few grand to pad a bill because of a complication could lead to a very large malpractice suit which at a minimum could lead higher malpractice insurance payments for the doctor, and financial loss to the hospital. I think too much is left out of this article to get an accurate picture.

 

[Steve]

Okay. Here are my opinions, things I believe to be true. Some are based upon fact, others on conjecture. Others are just based upon my own anecdotal experience. I'm not trying to change anyone's minds, and I don't expect that anyone here will change mine.

So, that said, I believe that, in general, where money is involved people will make concessions. Most people will maximize profit in ways that are, to them, harmless. For example, while it's inconvenient to get a second blood draw, it is largely innocuous to the patient's overall health. The entire medical system we have is set up to to maximize profit and minimize liability. I was hospitalized one time and had a steady stream of people moving through the room. They would introduce themselves, do something (who knows what) and the leave. They would then bill my insurance. All of them billed separately and each of them got paid handsomely, often for minutes of "work." I got what needed to be done, and felt as though I was adequately taken care of. But I also had no doubt that everyone was milking me for every penny I was worth, in large part adding zero value to my treatment. "Hi, I'm Dr. Smith, and I have been assigned to you by the hospital as your general practitioner. Do you have any questions? Great. Have a nice day." "Hi, I'm Dr. Jones, and I've been assigned by the hospital as the assistant to the general practitioner. Do you have any questions that Dr. Smith didn't answer? Excellent. Have a nice day. Oh, and Dr. Roberts will be in. She will be your pain specialist, in case you're in pain." And so on...

JKS, from your back surgery, I would guess that you'll receive no fewer than 10 different bills from different companies, all representing different interests.

I trust cops to do their jobs, but also believe that many cops are jaded and suspicious. I believe that doctors and nurses want to help people get well, but also believe that they are in BUSINESS and will use the system to maximize profit.

I am a staunch supporter of public schools, but believe that there is much that can be improved.

I'm a staunch supporter of members of the military, but have little trust for their leadership.

It boils down to this, for me. I can think of very few things for which I have unqualified trust or support. Where people are concerned, there will always be self-interest.

And I've made no bones about how I feel about our current medical system. I think it's broken and needs a complete overhaul, and that unregulated capitalism and a free market have no place within that system. In much the same way we do not have a privatized, for profit military, we should not have privatized, for profit medical.

 

[billc]

I trust cops to do their jobs, but also believe that many cops are jaded and suspicious. I believe that doctors and nurses want to help people get well, but also believe that they are in BUSINESS and will use the system to maximize profit.

I am a staunch supporter of public schools, but believe that there is much that can be improved.

I'm a staunch supporter of members of the military, but have little trust for their leadership.

I always find it funny that people have all these complaints about things controlled by the governement, cops, teachers, military...and then the next thing they go to is increasing the governments role in their healthcare. Of the two systems, the profit motive, or government virtue...I'll take people working under the profit motive any day. If you think the profit motive is a problem...wait till the person delivering your medical care has absolutely no incentive to do a better job because the odds they will be fired are slim to none, and they will recieve the same compensation no matter what care they give you...good luck with that...

Just think that politicians and the wealthy aren't going to the county Hospital for their medical treatment...or the V.A. They go to first class hospitals that are run by...the profit motive...

 

[Steve]

I always find it funny that people have all these complaints about things controlled by the governement, cops, teachers, military...and then the next thing they go to is increasing the governments role in their healthcare. Of the two systems, the profit motive, or government virtue...I'll take people working under the profit motive any day. If you think the profit motive is a problem...wait till the person delivering your medical care has absolutely no incentive to do a better job because the odds they will be fired are slim to none, and they will recieve the same compensation no matter what care they give you...good luck with that...

Just think that politicians and the wealthy aren't going to the county Hospital for their medical treatment...or the V.A. They go to first class hospitals that are run by...the profit motive...

I have few complaints. Believing that things can be improved and being realistic about people is different from complaining. At least, I'd like to think so.

I think that the police, in general, do a fine job. Overall, they are well trained, polite and generally effective. But that doesn't mean that they are perfect or that there are no problems with the way that they go about their business. Even on a local level.

I am VERY happy with my kids' education so far. The school district does things that I think are ineffective (sometime, if you're interested, I'll tell you about the laptop initiative), but my daughter is a sophomore. She's taking two University of Washington classes in the high school as well as an AP class. Next year, she's registered for 3 AP classes and two more UW classes. I'm very pleased with the quality of her education. And, in general, I think that the Kent school district does a fine job of handling all of the local kids, including kids who are either special education or high cap.

And with regards to medical, I think my family has been adequately taken care of, but believe that the money side of the equation is completely broken. Too many hands in the pot and everyone's taking advantage. I don't blame them. I blame the system that encourages what borders, frankly, on collusion, in my opinion.

I believe that government in general does a good job, too. Perfect? Absolutely not. Of the three issues above, I have way more faith in the cops and the schools than I do in the administrative side of health care. Of the three, the one that causes me the most concern is the privatized system.

Ultimately, I think that believing that everything is either all good or all bad is a very immature outlook. It's childlike. We should be grown up enough to be able to say, "This is mostly good, and overall, I'm happy. BUT, I'd like to see x, y, and z change in order to make it better."

 

[DennisBreene]

There is a misinterpretation of the term complication operating here. In medical usage, "complication" means that things did not occur exactly as expected. It does not necessarily imply that malpractice occurred. The patient who comes in with trauma and has surgery and has a heart attack after surgery has had a complication, as has the patient with a wound infection, extended time in ICU and any number of issues that can occur in the course of treatment. Humans are not machines and things go wrong (or sometimes just not right) for many reasons that are not predictable. While complications due to malpractice are part of the mix, they are not the totality. As one would reasonably expect, when events do not proceed as expected, the complications require treatment also. This is not padding or manipulation or fraud. It is simply the cost of getting a patient through a course of treatment. Within the professions, there is a concerted effort to identify predictable and preventable complications both for quality of care concerns and malpractice concerns. Some complications, such as bedsores are not compensated for by Medicare (and the trend is growing) as they are deemed to be so predictable and preventable that it is considered (by Medicare) to be substandard care for a patient to develop them. The majority of complications are variations from the normal course that are out of the control of the hospitals and the provider and are legitimate additional expenses.

 

[billc]

That's what I mean Dennisbreene, there isn't enough information given in the article to know what exactly the problem is.

 

[arnisador]

But do you think they purposely try to mess up to make more money? Or is it just a coincidence. I don't think docs and nurses would try to mess up or hurt people.

I agree. But if it costs the hospital money then the administrators will find ways to reduce the costs by identifying problematic health care providers and error-causing rules or lack-of-rules.

 

[jks9199]

There is a misinterpretation of the term complication operating here. In medical usage, "complication" means that things did not occur exactly as expected.

So... just to put it in concrete terms... My overnight stay on what was scheduled as outpatient surgery was a complication, right?

I have to note: the hospital did ask extensively about sleep apnea pre-surgery. And, while it was left in my hands, the did a lot to prevent infection, giving me a detailed protocol for bathing the night before and morning of my surgery, using special soap and sleeping on clean sheets. From the nurses's comments -- I suspect they don't get great compliance on that...

 

[Steve]

So... just to put it in concrete terms... My overnight stay on what was scheduled as outpatient surgery was a complication, right?

I have to note: the hospital did ask extensively about sleep apnea pre-surgery. And, while it was left in my hands, the did a lot to prevent infection, giving me a detailed protocol for bathing the night before and morning of my surgery, using special soap and sleeping on clean sheets. From the nurses's comments -- I suspect they don't get great compliance on that...

LOL... maybe it was you. If you'd comb your hair every once in a while!

I've been in surgery and never been advised to bathe in a particular way or sleep on clean sheets. The typical stuff I remember from surgeries for myself or my kids/wife are not to eat within a particular period of time, remove any jewelry and don't bring any valuables to the hospital.

Maybe the healthcare in the Seattle area is just not as good as elsewhere.

 

[jks9199]

LOL... maybe it was you. If you'd comb your hair every once in a while!

I've been in surgery and never been advised to bathe in a particular way or sleep on clean sheets. The typical stuff I remember from surgeries for myself or my kids/wife are not to eat within a particular period of time, remove any jewelry and don't bring any valuables to the hospital.

Maybe the healthcare in the Seattle area is just not as good as elsewhere.

Spinal surgery. Neither I nor the hospital have any interest in MRSA or other infections in my spine... For other surgeries with my wife, the protocol wasn't so extensive.

But I also get the idea it's not a universal practice.