"Never Events" and Hospital Infections -- An Impossible Goal?

I’ve written sympathetically about the efforts of Medicare and private insurers such as WellPoint to eliminate avoidable medical errors — particularly so-called “never events,” such as surgery on the wrong side of the body or operations that leave sponges or instruments inside the patient — by refusing to pay for follow-up care.

The plan still seems like a good one in principle, but as the list of so-called “never events” continues to expand, the risk that it may jeopardize medical care in new and different ways is starting to rise.

Back in April, I took a look at some objections raised by Roy Poses of Health Care Renewal regarding the preventability of patient delirium. Today’s installment involves a more recent post by Val Jones over at Revolution Health, in which the good doctor suggests that hospital-acquired infections may also be impossible to avoid, and that jeopardizing hospital revenue via the “never event” mechanism is more likely to lead to overtreatment and other undesirable patient-care approaches:

I could go on theorizing, but you get the picture. In my opinion, the “never events” strategy is fatally flawed and will result in excessive litigation, ping-ponging of patient care, over-use of antibiotics, increases in adverse drug events, a rise in multi-drug resistant bacteria, and further reduction of services to the poor. A more reasonable approach would have been to document infection rates at the most hygienic facilities, and offer incentives for others to strive for similar rates.

The “never events” strategy is destined to do more harm than good for patients with hospital acquired infections, though the medical malpractice attorneys may enjoy a new income stream. This is just one more reason why we should never say never.

While Dr. Val isn’t exactly wrong here, I think she’s only scratching the surface. The real problems have less to do with the never-event goals than with the way hospitals are reimbursed in the first place, the general inability of anyone to look at their outcomes data and the widening gulf between their patient-care mission and their financial goals.

I totally agree that the never-event mechanism is a blunt weapon — but sometimes you really have to whack the mule with a two-by-four to get its attention. Had hospitals shown the slightest interest in addressing the issue of medical error on their own, we wouldn’t be having this discussion today.