From the Editor (Brian Nash):
The following is the first of many blogs-to-come by our new associate lawyer, Jason Penn. Read about Jason’s background and enjoy reading his first venture into the blogosphere of medicine-law-healthcare.
By: Jason Penn
Prince George’s Hospital Center finds itself at the top of yet another dubious list. With 4 out of every 1,000 patients experiencing a complication, Prince George’s Hospital has failed to meet a target for the prevention of complications set by the Maryland Health Services Cost Review Commission.
The penalty for Prince George’s Hospital? The hospital’s ‘rate increase’– or how much the hospital can charge for services rendered — will be lowered by $890,000 for next year. The State uses a payment-related methodology to reduce the frequency of hospital-based complications. The State of Maryland has the authority to establish hospital payment levels applicable to both private insurance companies and public insurers such as Medicare and Medicaid. The methodology links payments to hospital performance on a list of 52 acquired conditions. These conditions are complications that are unlikely to be a consequence of the natural progression of an underlying disease. The program seeks to eliminate some of the most serious and injurious patient complications in Maryland’s 47 acute care hospitals: bed sores, infections, accidental punctures or cuts during medical procedures, strokes, falls, delivery with placental complications, obstetrical hemorrhage without transfusion, septicemia, collapsed lungs and kidney failure.
The Maryland Hospital Acquired Conditions Initiative, begun in 2009, is an effort to tie financial incentives and penalties to how well hospitals perform in reducing life threatening, dangerous and preventable complications. Maryland’s motivation in starting the initiative is not pure; rather, as the Commission’s name suggests, it is a cost savings measure. Patient safety taking an apparent backseat, the Commission recognized that many of the complications that occur in the hospital setting are costly, to the tune of $521 million in 2010.
Prince George’s Hospital Center is not alone, however. Eight other Maryland and Washington D.C. area hospitals will face penalties for complications. Doctors Community, Washington Adventist, Montgomery General, Shady Grove Adventist, University of Maryland Medical Center, St. Joseph Medical Center, and Civista Medical Center of Cumberland, Maryland have been penalized due to their failure to meet targets for the prevention of complications. Those hospitals will lose a combined $2.1 million in the amount they can charge patients, according to a story first reported by Kaiser Health News.
The Commission’s Executive Director Robert Murray noted in a news release that in fiscal year 2008, the Commission estimated preventable, hospital-based complications were seen in “55,000 of the State’s total 800,000 inpatient cases,” representing $522 million in hospital payments that could have potentially been avoided. The number of complications is staggering: The University of Maryland Medical System had an observed number of complications of 1223 cases; Prince Georges Hospital had 553; while Montgomery General Hospital had 304 listed. All three hospitals were worse than the state average.
In the original Kaiser Health article, Mr. John O’Brien, president of Prince George’s Hospital noted that “the problem mainly lies in how the hospital tracks, codes and reports data, not in patient care.”
One thing seems certain – Prince George’s Hospital is failing. The numbers certainly suggest that it is failing in its patient care responsibilities yet Mr. O’Brien reports that it is merely a “failure of its tracking system.” If, theoretically, it is as Mr. O’Brien says – that the tracking system is faulty, how does he conclude that the system is creating false positives and is not underreporting the errors? The common thread is clear. Prince George’s and other local hospitals are failing, either at tracking untoward events or at patient care and likely injuring their patients in the process.
The truly frightening aspect is that there are an untold number of patients that were irreparably harmed by these complications. At first blush, the State’s attempt is laudable, clearly designed to hit the hospitals in their wallets for its misgivings. The penalties notwithstanding, the State’s initiative offers no mechanism to compensate the victims of these hospital complications. Every indication is that the injured patients and their advocates are left to pursue alternative avenues to obtain compensation for these so-called “complications.”