Monday, August 20, 2007

Bad Problem, Wrong Solution

Once again our Congress, deftly and skillfully guided by corporate and big-money interests, has passed a whopper of a bill to address a serious problem without actually having any effect on the problem. Read about it here.

The problem our representatives were addressing was that more than 80,000 Americans die each year from infections and other maladies they get while in the hospital, which did not exist before their admission. This is bad! This is scandalous! This is avoidable! What should be done?

Congress, in it's wisdom, recognized it holds the purse-strings of Medicare, which alone supports many hospitals, and forms a major source of funds for almost every hospital in the country. So they decided to stop paying the hospitals for patient care of conditions which were acquired at the hospital, and which should have been avoidable. They also included some language that would promote extra testing of patients before admission to determine whether they have infections already.

The problem is, Medicare is there to pay for a patient's care! If grandma goes into the hospital, Medicare is supposed to pay for her care until she is released to go home, no matter what her health problem is. Say she goes in to gall-bladder surgery. Fine. Operation and recovery covered. now, consider if she gets sepsis from a badly installed IV line. Suddenly, grandma has a raging infection which is life-threatening-- probably more dangerous than the gall-bladder malady. But for the infection she is no longer covered by Medicare. The hospital will (I hope, and do believe) treat the infection, but won't be able to charge Medicare. They cannot, however, by current regulations, charge grandma.

Most hospitals plan for and set aside contingency funds for this kind of outcome. They self-insure (often through deductibles on their liability insurance) against actionable and potentially expensive outcomes. When grandma gets home and healthy, she's just going to have to file a lawsuit against the hospital to recover the costs that weren't covered by Medicare. Instead of talking to the insurance company about non-permitted charges, she can speak with her lawyer. Instead of a decision in days or weeks, she can look forward to a decision in months or years. Instead of the payment coming from the insurance company (or Medicare), it will come from the liability insurer, and ultimately likely out of the hospital's pocket. Who will increase their charges to cover the loss.

Net result? Higher hospital charges, more complicated process for determining charges, involvement of lawyers and tortious proceedings to resolve coverage issues. More testing at the time of admission. Large piles of money, in the form of exposures, are moved from desk to desk among coverage providers. Will this lead to any fewer "avoidable" bad outcomes? Doubtful.

Once again, Congress through a series of compromises and committee decisions has fashioned an unworkable law that doesn't solve the problem at hand.