Making Hospitals Pay For Own Mistakes

Some Insurance And States Are Refusing To Foot Bill When Hospitals Mess Up

(CBS)  William Doyle survived his open-heart surgery - but was almost killed, days later, by a hospital mistake, CBS News correspondent Wyatt Andrews reports.

"At the time, I very easily could have died from this infection," Doyle said.

It was a chest infection, caused by a breakdown in hospital cleanliness. After a second operation and months of extra care, the bill to treat his infection was almost double the charge for his surgery.

As Doyle noted, the complication was more expensive than original problem.

What to do about big, expensive hospital mistakes is a question about to be answered in a revolutionary way. Both the Medicare system and several large insurance companies have said they won't pay hospitals any more for certain preventable errors.

Beginning in October, Medicare will no longer pay for eight hospital mistakes - including:

Urinary infection from catheter

Bed sores

Surgical object left in body

Air embolism

Giving wrong type of blood

Blood infection from catheter

Chest infection after bypass surgery

Hospital-caused injury

"We think it's a big deal," said Kerry Weems, Medicare's acting administrator. He says when the system stops paying for preventable mistakes, hospitals will stop making them.

"And that's what this is really about, avoiding errors and improving the quality of care for everybody," he said.

One state, Pennsylvania, is already refusing to pay for errors.

It's Medicaid program lists 27 mistakes called "never events," including "surgery done on the wrong body part" and medication leading to injury or death.

Medication error is what almost killed the twins born to actor Dennis Quaid and his wife Kimberly. They told 60 Minutes correspondent Steve Kroft how the twins got massive overdoses of the blood thinner heparin.

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Read Steve Kroft's full 60 Minutes report.

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And "never event," said Governor Ed Rendell, means the state will never pay.

"Its not just about constraining costs, its about saving lives," he said. "Preventable medical errors cause more deaths in this country than Alzheimer's, diabetes, almost to the level of stroke. That's stunning, isn't it?"

Already some innovative hospitals are working to eliminate mistakes. Before every bypass surgery, surgeons in the Geisinger Health System in Pennsylvania use a 40-step safety list.

And if there is any error, the hospital pays. No added expense are charged to the patient or insurance company. It's like a warranty, and after two years, they say it's working.

"We've had fewer complications, fewer mortalities, generally all these clinical outcomes are moving in the right direction," Dr. Ronald Paulus of the Geisinger Health System said.

For decades, the U.S. health care system has paid doctors and hospitals by the services performed, even if those services harmed the patient.

To many experts the real question is: Why did it take so long to stop paying for preventable mistakes?

© MMVIII, CBS Interactive Inc. All Rights Reserved.

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Add a Comment See all 16 Comments

by mogoal March 17, 2008 8:14 PM PDT

Hospitals, Hospices, nursing homes etc. make mistakes every day that leave patients sick or in the case of my family dealing with the death of an elderly father in-law. There appears to be so much cover up that goes on between the doctors, nurses and administrative staff that it leaves me wondering why they not prosecuted for their dishonesty? I feel angry that this goes on every day and these so called health centers are allowed to be above the law.

Reply to this comment

by electrablue-2009 March 17, 2008 9:17 PM PDT

The number one reason anywhere for mistakes is under staffing. The reason for understaffing is partial payment such as medicare does nationally.Your reporter should follow any nurse''s footsteps for one week and then come back and tell everyone how mentally and physically draining it is. Does the general public know that hospitals have more bacteria and more viruses than anyplace else. It''s common sense, just think about it. Where do you find sick people. We try very hard to make hospitals very clean, but it doesn''t mean their sterile. If we do our best, our best is not perfect. Stop payment on medical costs then start closing "Hospitals."

Reply to this comment

by lilpunk118 March 17, 2008 9:53 PM PDT

I wonder if these insurance companies are going to start denying payment for mistakes, how much are they saving a year and how much of a rate cut can I expect to see? They can''t save money and not pass it down to the consumer.... oh wait, yes they can and noone will do anything about it!

Reply to this comment

by dvillegas43-2009 March 18, 2008 10:09 AM PDT

Good concept except for one thing, the hospital will turn around and bill the patient. If the patient can''t or won''t pay, the hospital will ruin his credit, send the bill to a collection agency etc. This is smoke and mirrors by Medicare and big insurance. There is very little to protect the consumer.

Reply to this comment

by rf35 March 18, 2008 10:57 AM PDT

The concept is sound: hit them in the wallet and they will find a way to protect themselves. The problem is that the protection may come in unintended ways. Between hospitals turned into corporations and the national scam known as the insurance industry, Americans are really taking it in the back door when it comes to health care. I''ve never been big on the idea of socialized medicine, but maybe the universal health care idea can help. The situation has gotten that far out of control. These corporations have us by the balls and they know it.

Reply to this comment

by enriquecaliente March 18, 2008 1:00 PM PDT

"Good concept except for one thing, the hospital will turn around and bill the patient. If the patient can''''t or won''''t pay, the hospital will ruin his credit, send the bill to a collection agency etc. This is smoke and mirrors by Medicare and big insurance. There is very little to protect the consumer."

So true, the only thing left would be to counter sue the hospital, the staff and the surgeon and make them pay all of your legal fees too. What kind of idiot on the bench as a judge would not be able to see the stupidity of the hospital trying to charge you for a mistake they made. Oh Yes, I forget. Most if not all Judges are in the pockets of the corporation''s. Sorry.

Reply to this comment

by janetp1974 March 18, 2008 2:02 PM PDT

Dvillegas43 has it right. My mother died due to chemotherapy improperly administered in one of those PA hospitals. The nurse did not get the pre-chemo meds into the port properly and they leaked onto the bed. The call button was hung on the wall, out of reach. And there was one nurse on duty for 15 chemo patients. She quit breathing and was taken to the ER, where they worked for 15 minutes to get her going again. She had to go to a nursing home, and died not long after. Yet they tried to get us to pay the aborted chemo session and the ER and ICU charges.

Reply to this comment

by captandrea March 18, 2008 2:13 PM PDT

My father was infected with MRSA staph infection while undergoing a repair job to a "minor" heart (Leaky Valve) surgery. The surgeon had knicked the pericardium during the original procedure. As a result he had to undergo multiple additional open heart surgeries leaving him in Cardiac ICU for 3 months - most of the time in a drug induced coma with his chest wide open. Somehow he survived this ordeal and was finally returning to a normal life after 3 years of recovery, only to be diagnosed with leukemia, and to lose his life in 2004..

Reply to this comment

by tlparp March 18, 2008 3:10 PM PDT

Refusing to pay for mistakes is one thing, refusing to pay for bad outcomes is another thing entirely. I''m a nurse in an intensive care unit, and I see infections and bad outcomes every day. But a lot of these bad outcomes are not preventable, they are a result of people being horribly sick before they ever get to the hospital. I see the staff washing their hands repeatedly and using the hand sanitizer provided. But then I see a patient''s family member hug the patient, walk out of the room, push the button to open the door, then push the elevator button as they leave. Then the next family member comes in, pushes the elevator button, opens the door, enters their family member''s room, hugs them. The germs from the first patient just left his room, went for a ride down the elevator, then came back up and into the 2nd patient''s room. I as a nurse can wash my hands 500 times a day, but all it takes is one family member shaking hands in the lobby with another family member, and then not washing their hands. I''m not blaming families for the problems, I just don''t think we can prevent every infection, and somehow it doesn''t make sense to me to refuse to pay for something that we as healthcare providers have little control over.

Reply to this comment

by mswolfestock March 18, 2008 3:42 PM PDT

I can already see how the hospitals will get around this. They will just make you and/or your family sign a bunch of release forms prior to performing any kind of procedure. You already have to sign oodles of forms anyway, and the hospitals are betting on the fact that you will probably not read most of what you are signing. The hospital will sneak in a form that releases them from any responsibility for mistakes, and then you will be left with nothing. SUGGESTION: TAKE A LAWYER WITH YOU THE NEXT TIME YOU GET SICK.

Reply to this comment

by dehulsey March 18, 2008 4:49 PM PDT

In 1992 my 55 year old father went into Tuscaloosa, AL''s only hospital, DCH, for hemmorhoid surgery and died 5 weeks later of Strep infection he got while in the hospital. That place was and still is unclean. I think this is good news. We need our hospitals clean.

Reply to this comment

by godseyesore-2009 March 18, 2008 5:35 PM PDT

If insurance refuses, then insurance company should bear cost of suing hospital and/or physician(s). If companies win, hosp/phy pays. Lose, insurance company pays.
What''s the big deal?

Reply to this comment

by cyberus-2009 March 18, 2008 7:33 PM PDT

Medicine (human and veterinary) are one of the few industries that can profit from mistakes .. construction is another.

About time someone started making them take responsibility for their errors without requiring a court battle.

Now (IMO) the states need to implement some law to prevent (as someone mentioned) billing of the people that were hurt after the state/insurance company refused to pay.
Perhaps a "civilian review board" TYPE system should be instituted. 2 civilians, 2 medically trained reviewers, 1 medical law judge as arbitrator/tie breaker. A "instrument left in body" case would get a "surgical error" rubberstamp .. an infection case (as someone mentioned earlier) could be reviewed to see if it was error or a case of "grandkids with dirty hands visiting".

Reply to this comment

by Netterz March 18, 2008 8:10 PM PDT

Its already on the hospital papers you sign. You are responsible for any and all bills NOT paid by your insurance co. So, unless you have the time, money,and good lawyers, are you going to survive this latest way Corp America has worked hard to destroy your credit,so they can then charge you unreal fees and interest rates, and continue the constant raping of your wallet ,every scond of every day. When the Gov''t says they will NOT be allowed to bill the patient, or there family they left behind, I ill fall over dead on the spot.

Reply to this comment

by alarchdu March 19, 2008 9:13 AM PDT

Why would a hospital admit to making mistakes? UK and Australian hospitals hate to admit to making mistakes resulting in "adverse reactions" such as hospital-acquired infections, when the only outcome is bad publicity. You expect them to admit to mistakes that cost them money? From my viewpoint Downunder, this approach seems just another way of health funds exercising control of hospitals for financial benefit, not patient good health.

Neville J. Angove

Reply to this comment

by bloggerbud March 20, 2008 6:13 PM PDT

Two of these rules are really going to backfire.
People can get infections from catheters either in the bladder or in the blodd though absolutely no fault from anyone. It just happens when you put a foreign body into someone.

Now we will have to give antibiotic to everyone with a line in place in order to try and protect against this "error". That will cause folks to get antibiotic resistance and really raise costs.

Not paying for an error will not make it go away, Folks. This is a bad, bad road we''re going down.

Reply to this comment

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[mogoal]

Hospitals, Hospices, nursing homes etc. make mistakes every day that leave patients sick or in the case of my family dealing with the death of an elderly father in-law. There appears to be so much cover up that goes on between the doctors, nurses and administrative staff that it leaves me wondering why they not prosecuted for their dishonesty? I feel angry that this goes on every day and these so called health centers are allowed to be above the law.

[electrablue-2009]

The number one reason anywhere for mistakes is under staffing. The reason for understaffing is partial payment such as medicare does nationally.Your reporter should follow any nurse''s footsteps for one week and then come back and tell everyone how mentally and physically draining it is. Does the general public know that hospitals have more bacteria and more viruses than anyplace else. It''s common sense, just think about it. Where do you find sick people. We try very hard to make hospitals very clean, but it doesn''t mean their sterile. If we do our best, our best is not perfect. Stop payment on medical costs then start closing "Hospitals."

[lilpunk118]

I wonder if these insurance companies are going to start denying payment for mistakes, how much are they saving a year and how much of a rate cut can I expect to see? They can''t save money and not pass it down to the consumer.... oh wait, yes they can and noone will do anything about it!

[dvillegas43-2009]

Good concept except for one thing, the hospital will turn around and bill the patient. If the patient can''t or won''t pay, the hospital will ruin his credit, send the bill to a collection agency etc. This is smoke and mirrors by Medicare and big insurance. There is very little to protect the consumer.

[rf35]

The concept is sound: hit them in the wallet and they will find a way to protect themselves. The problem is that the protection may come in unintended ways. Between hospitals turned into corporations and the national scam known as the insurance industry, Americans are really taking it in the back door when it comes to health care. I''ve never been big on the idea of socialized medicine, but maybe the universal health care idea can help. The situation has gotten that far out of control. These corporations have us by the balls and they know it.

[enriquecaliente]

"Good concept except for one thing, the hospital will turn around and bill the patient. If the patient can''''t or won''''t pay, the hospital will ruin his credit, send the bill to a collection agency etc. This is smoke and mirrors by Medicare and big insurance. There is very little to protect the consumer."

So true, the only thing left would be to counter sue the hospital, the staff and the surgeon and make them pay all of your legal fees too. What kind of idiot on the bench as a judge would not be able to see the stupidity of the hospital trying to charge you for a mistake they made. Oh Yes, I forget. Most if not all Judges are in the pockets of the corporation''s. Sorry.

[janetp1974]

Dvillegas43 has it right. My mother died due to chemotherapy improperly administered in one of those PA hospitals. The nurse did not get the pre-chemo meds into the port properly and they leaked onto the bed. The call button was hung on the wall, out of reach. And there was one nurse on duty for 15 chemo patients. She quit breathing and was taken to the ER, where they worked for 15 minutes to get her going again. She had to go to a nursing home, and died not long after. Yet they tried to get us to pay the aborted chemo session and the ER and ICU charges.

[captandrea]

My father was infected with MRSA staph infection while undergoing a repair job to a "minor" heart (Leaky Valve) surgery. The surgeon had knicked the pericardium during the original procedure. As a result he had to undergo multiple additional open heart surgeries leaving him in Cardiac ICU for 3 months - most of the time in a drug induced coma with his chest wide open. Somehow he survived this ordeal and was finally returning to a normal life after 3 years of recovery, only to be diagnosed with leukemia, and to lose his life in 2004..

[tlparp]

Refusing to pay for mistakes is one thing, refusing to pay for bad outcomes is another thing entirely. I''m a nurse in an intensive care unit, and I see infections and bad outcomes every day. But a lot of these bad outcomes are not preventable, they are a result of people being horribly sick before they ever get to the hospital. I see the staff washing their hands repeatedly and using the hand sanitizer provided. But then I see a patient''s family member hug the patient, walk out of the room, push the button to open the door, then push the elevator button as they leave. Then the next family member comes in, pushes the elevator button, opens the door, enters their family member''s room, hugs them. The germs from the first patient just left his room, went for a ride down the elevator, then came back up and into the 2nd patient''s room. I as a nurse can wash my hands 500 times a day, but all it takes is one family member shaking hands in the lobby with another family member, and then not washing their hands. I''m not blaming families for the problems, I just don''t think we can prevent every infection, and somehow it doesn''t make sense to me to refuse to pay for something that we as healthcare providers have little control over.

[mswolfestock]

I can already see how the hospitals will get around this. They will just make you and/or your family sign a bunch of release forms prior to performing any kind of procedure. You already have to sign oodles of forms anyway, and the hospitals are betting on the fact that you will probably not read most of what you are signing. The hospital will sneak in a form that releases them from any responsibility for mistakes, and then you will be left with nothing. SUGGESTION: TAKE A LAWYER WITH YOU THE NEXT TIME YOU GET SICK.

[dehulsey]

In 1992 my 55 year old father went into Tuscaloosa, AL''s only hospital, DCH, for hemmorhoid surgery and died 5 weeks later of Strep infection he got while in the hospital. That place was and still is unclean. I think this is good news. We need our hospitals clean.

[godseyesore-2009]

If insurance refuses, then insurance company should bear cost of suing hospital and/or physician(s). If companies win, hosp/phy pays. Lose, insurance company pays.
What''s the big deal?

[cyberus-2009]

Medicine (human and veterinary) are one of the few industries that can profit from mistakes .. construction is another.

About time someone started making them take responsibility for their errors without requiring a court battle.

Now (IMO) the states need to implement some law to prevent (as someone mentioned) billing of the people that were hurt after the state/insurance company refused to pay.
Perhaps a "civilian review board" TYPE system should be instituted. 2 civilians, 2 medically trained reviewers, 1 medical law judge as arbitrator/tie breaker. A "instrument left in body" case would get a "surgical error" rubberstamp .. an infection case (as someone mentioned earlier) could be reviewed to see if it was error or a case of "grandkids with dirty hands visiting".

[Netterz]

Its already on the hospital papers you sign. You are responsible for any and all bills NOT paid by your insurance co. So, unless you have the time, money,and good lawyers, are you going to survive this latest way Corp America has worked hard to destroy your credit,so they can then charge you unreal fees and interest rates, and continue the constant raping of your wallet ,every scond of every day. When the Gov''t says they will NOT be allowed to bill the patient, or there family they left behind, I ill fall over dead on the spot.

[alarchdu]

Why would a hospital admit to making mistakes? UK and Australian hospitals hate to admit to making mistakes resulting in "adverse reactions" such as hospital-acquired infections, when the only outcome is bad publicity. You expect them to admit to mistakes that cost them money? From my viewpoint Downunder, this approach seems just another way of health funds exercising control of hospitals for financial benefit, not patient good health.

Neville J. Angove

[bloggerbud]

Two of these rules are really going to backfire.
People can get infections from catheters either in the bladder or in the blodd though absolutely no fault from anyone. It just happens when you put a foreign body into someone.

Now we will have to give antibiotic to everyone with a line in place in order to try and protect against this "error". That will cause folks to get antibiotic resistance and really raise costs.

Not paying for an error will not make it go away, Folks. This is a bad, bad road we''re going down.