Permit me to be skeptical. Back in 2007, Medicare began requiring hospitals to identify secondary diagnoses that patients have when they're admitted to the hospital or arrive in the ER. In cases where patients develop a secondary condition that was not present on admission, the hospitals don't get paid extra for treating them. Yet these regulations have not lowered infection rates. It's unlikely that a one percent reduction in Medicare payments for treating hospital-acquired infections will have a much greater effect.
As I noted in an earlier post, hospitals are reluctant to discipline doctors who violate safety rules, because some of those doctors admit many of the hospitals' patients and perform their big-ticket procedures. Moreover, there's an unwritten rule in hospitals that administrators cannot interfere in clinical activities, because they're not physicians. Only the hospital's medical leaders or the executive medical committee has the right to make rules for doctors in the clinical sphere.
According to a recent report from the National Patient Safety Foundation, the best way to start making hospitals safer is to change the way that medical students are taught. In this view, medical schools have a responsibility to train students in safe practices and show them how to collaborate with others to create a safer hospital environment.
Well, that's a great idea, but do we really want to wait until the next generation of physicians assumes leadership positions in hospitals to do something about safety? When up to 100,000 people a year are dying from infections they contracted in hospitals, we need more immediate, radical action. And that's not just me speaking. AHRQ says that the issue demands "urgent attention."
If the Senate confirms Donald Berwick as the new chief of Medicare and Medicaid, perhaps we'll start to see a heightened focus on patient safety. As president of the Institute for Healthcare Improvement (IHI), Berwick has fought long and hard to get hospitals to adopt processes that enhance safety and reduce infections. While he can't go beyond what Congress has authorized in the Affordable Care Act, he could seek approval for demonstration projects that would show how to make care safer. If Medicare showed that it was truly serious about this issue, hospitals would pay attention.
Image supplied courtesy of Wikimedia Commons.