No money for mistakes.

Byline: The Register-Guard

Doctors and hospitals have powerful incentives to make fewer mistakes, not the least of which is a profound professional desire to help their patients heal as quickly as possible. They go to great lengths to reduce medical errors and to refine procedures to continually make the practice of medicine safer. This, in turn, reduces malpractice lawsuits and related insurance premiums, and it improves outcomes for patients. Everyone wins.

In spite of all that's being done, the Centers for Disease Control and Prevention estimates that every year, 99,000 patients - 270 people a day - die from infections they acquiredafterthey entered the hospital.

The Agency for Health Care Research and Quality, the federal agency charged with improving health care quality and safety, has found that about 32,000 patients are injured annually in hospitals, often from preventable medication errors. The injuries occur when patients are given too much or too little medication or the wrong drug entirely.

These are lives that, by and large, can be saved and patient injuries that can be prevented.

Another effective tool for health care improvement is the power of the purse. If third party payers withhold reimbursement when doctors and hospitals make preventable mistakes, the incentive to avoid errors becomes even greater.

That's the rationale behind the Centers for Medicare and Medicaid Services' new policy to no longer pay for eight specific conditions that could generally be eliminated if hospitals followed proven preventive procedures or common-sense precautions.

Under current payment rules, Medicare typically pays hospitals for correcting mistakes or treating infections even if the problem is caused by incompetence or failure to follow no-brainer sanitary practices as simple as hand-washing.

Beginning on Oct. 1, 2008, Medicare will stop paying hospitals to retrieve surgical tools or sponges left in a patient after the initial operation; for infections caused by prolonged use of catheters in the bladder or blood vessels, or a surgical site infection after coronary artery bypass surgery; for treating bedsores developed in the hospital or injuries caused by falls in the hospital; or for giving a patient an incompatible blood type or an air embolism.

Hospitals are allowed to ask for a review of any disputed charge, but if Medicare administrators determine that the problem arose there, the hospital will have to absorb the cost. The new rules prohibit hospitals from billing patients or insurers to recover any of the costs.

These are practical, sensible rules that patients should welcome, even if they prompt some additional tests and costs in the short run. The list was vetted by experts to make sure the conditions that no longer qualify for reimbursement are within a typical hospital's control.

That doesn't mean the rules can't be tweaked down the line. Hospitals raise legitimate concerns about some patients who are so prone to bedsores that they can't be completely prevented even with the best care. Likewise, the rules will force hospitals to screen new patients in order to determine whether they had an infection prior to being admitted.

The bottom line is the bottom line: Medicare spent more than $185 billion on hospital care in 2006. For that kind of money, taxpayers have a right to expect that everything possible is being done to eliminate preventable errors.