Pros and cons of not reimbursing hospitals

Pros and cons of not reimbursing hospitals

Pros and cons of not reimbursing hospitals

I have to agree with my peer discussions no more than 150 words each

2a. There are many pros and cons of not reimbursing hospitals for never events. Never events are described as “foreign object retained after surgery, air embolism, blood incompatibility, stage III and IV pressure ulcers, falls and trauma, catheter-associated urinary tract infection, vascular catheter-associated infection, surgical site infection (mediastinitis) after coronary artery bypass graft, surgical site infections following certain elective procedures (certain orthopedic surgeries and bariatric surgery), certain manifestations of poor control of blood sugar levels, deep vein thrombosis or pulmonary embolism following total knee replacement and hip replacement” (slide 54). “To be included on NQF’s list of “never events”, an event had to have been characterized as: Unambiguous—clearly identifiable and measurable, and thus feasible to include in a reporting system; Usually preventable—recognizing that some events are not always avoidable, given the complexity of health care; Serious—resulting in death or loss of a body part, disability, or more than transient loss of a body function; and Any of the following: Adverse and/or, Indicative of a problem in a health care facility’s safety systems and/or,Important for public credibility or public accountability” (slide 55). “An infection that occurs after a coronary artery bypass graft can cost as much as $30,000 to treat. Similarly, the 257,412 cases of Stage III and IV pressure ulcers in 2007 (not present on admission) cost a non-reimbursable average of $43,180 per stay.  And 193,566 cases of falls and trauma cases in 2007 cost an average of $33,894 per patient” (slide 56). The example given in slide 56 demonstrates both the pros and cons of not reimbursing hospitals for never events. The con of  not of reimbursing hospitals for never events is that they are not getting the money they need to treat their mistakes on patients. However, I believe this is more of a pro than a con for hospitals, insurance companies and patients. I believe that not reimbursing hospitals for never events will help physicians and other medical professionals be more mindful and cautious of their treatments. “It also raises the possibility of changes in medical practice as doctors focus more closely to clinical guidelines and hospitals perform more tests to assess the condition of patients at the time of admission. Hospital executives worry that they will have to absorb the costs of these extra tests because Medicare generally pays a flat amount for each case. While hospital executives said the policy would require them to collect large amounts of data they did not now have” (slide 60). Slide 60 discusses both the pros and cons. The pros are that hopefully physicians and other medical professionals will adhere more closely to guidelines and protocols. The cons are that hospitals will have to run more tests in the beginning of admission and throughout hospital visits to back themselves up. However, this is coming out of their pocket so they can be more accurate, it is not coming out of the pockets of insurance companies. I believe this is a good strategy to reduce medical errors because I can see physicians and medical professionals making careless mistakes because they know hospitals will receive the money for their mistakes from insurance companies. I think this will enforce physicians to be more mindful and accurate with their decisions and advice towards patients. I think this will also bring more awareness to medical errors that are not always spoken about. I believe this will bring change for the better in Health Care.  Pros and cons of not reimbursing hospitals



Powerpoint #6: “ Introduction to Medical Errors

2b.One of the pros of not reimbursing hospitals for never events is that it will save Medicare $20 million a year.

I think it is a good strategy to reduce medical errors because it “raises the possibility of changes in medical practice as doctors focus more closely on clinical guidelines and hospitals perform more tests to assess the condition of patients at the time of admission” (Introduction to Medical Errors, 60). Hospitals will try to prevent the occurrence of never events from happening. They will improve the quality of care and services and be more careful. However, because of these new tests and guidelines, hospitals will have to worry about absorbing the costs of these extra tests. Medicare would usually pay a flat amount for each case (Introduction to Medical Errors, 60).Pros and cons of not reimbursing hospitals


(PowerPoint: “Introduction to Medical Errors”)

3a.Based on material in the PowerPoint: “Tort Reform” the types of reforms that are more likely to succeed would be limited attorney contingency and the abolition of collateral source rule. Limited attorney contingency fees would be a great reform where the lawyer receives a percentage of the damage award.  This enables victims of negligence of “all economic levels to bring suit from injuries resulting from negligence” (Foote, 2015, slide 16). It will also ensure that lawyers will not take advantage of people and bring on unnecessary suits since they will only receive payment if there is a win (Foote,2015).  The abolition of collateral source rule is another reform that would likely succeed.  It is a rule that prohibits juries from hearing evidence that claimants have been fully or partially compensated from other sources for their injuries”(Foote, 2015, slide 15). Many states have already set this in place.  This is helpful because evidence regarding a person receiving compensation from their insurance company, etc can involve decisional bias and change a juror’s mind in their final decision.While reading we learn that the Safe Harbor Rules shield physicians from lawsuits where they are known to be following accepted guidelines. Safe harbor rules are set in place to protect doctors from getting sued for unnecessary charges.  There guidelines are set in place for physicians to follow and if they followed the steps necessary to properly care for their patient and an unfortunate occurrence happened they cannot and should not be held accountable (Foote, 2015). In the long run, the safe harbor rule will not drastically decrease the malpractice suits but may initiated but rather make physicians more aware of the clinical guidelines set in place to ensure patient safety and improve patient care.Reference:Foote, S. (2015) “Tort Reform”[PowerPoint slides]. Retrieved fromTORT REFORM REVISEDD 4-1-15.pptx

3b I believe increase rate of litigation is likely to succeed. This reform offers, “periodic payment of damages, mandatory pretrial screening panels, optional arbitration of malpractice cases” (slide 27). Periodic payment allows a defendant to pay over time instead of a lump sum, this prevents them from going bankrupt. “Arbitration is permitted in some states, often as a prerequisite to litigation, and may address liability and amount of damages” (slide 21). “Review/Screening panels are used as a pre-trial screening mechanism. Finding may or may not be submitted as evidence” (slide 22). “There is mixed evidence on screening panels, with one research team finding that the panels reduce obstetricians’ and gynecologists’ premiums by 20% and others finding that the panels may increase claim frequency by making expert evaluations more accessible” (slide 23).  “Experts have been promoting a type of reform known as “safe harbor rules,” which would shield physicians from lawsuits in cases where they were known to be following accepted clinical guidelines. For example, a patient who develops metastatic prostate cancer could not sue his physician for failing to screen him for that cancer if safe harbor rules include recent guidelines concluding the prostate screening is not routinely indicated. The goal of safe harbor rules is to protect doctors from frivolous lawsuits” (slide 32). “In short, safe harbor legislation will not necessarily reduce the number of medical malpractice suits in the U.S. But it might improve patient care, by focusing physicians on the importance of following carefully crafted clinical guidelines” (slide 34). I believe in what is stated in the power points. I do not think that malpractice will go away, however, I believe these reforms will bring some sort of awareness to medical professionals and their decisions will change for the better. I think patient care will increase and that there will be better quality of care. Physicians will be more cautious and accurate with their advice and decisions.


Powerpoint #5: “Tort Reform”

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