The Wisdom and Justice of Not Paying for “Preventable Complications”
- Peter J. Pronovost, MD, PhD;
- Christine A. Goeschel, RN, MPA, MPS;
- Robert M. Wachter, MD
- Author Affiliations: Departments of Anesthesiology and Critical Care Medicine (Dr Pronovost and Ms Goeschel), Surgery and Health Policy & Management (Dr Pronovost), and School of Nursing (Ms Goeschel), Johns Hopkins University, Baltimore, Maryland; and Division of Hospital Medicine, University of California, San Francisco (Dr Wachter).
Since this article does not have an abstract, we have provided the first 150 words of the full text.
- KEYWORDS:
- HOSPITALS
- IATROGENIC DISEASE
- MEDICAL ERRORS
- PATIENT SAFETY
- QUALITY OF HEALTH CARE
- REIMBURSEMENT MECHANISMS
Far too many patients experience preventable harm from medical care in US hospitals. To promote quality and safety, many employers and insurers are linking financial incentives to clinical performance. These programs, often called pay for performance, use a carrot (pay more for better quality) or a stick (pay less for lower quality). To date, most pay-for-performance programs have encouraged physicians to use evidence-based interventions or improve patient satisfaction.1
The Centers for Medicare & Medicaid Services (CMS) has taken the lead, with many insurers following, in linking pay for performance to reducing harm.2 In October 2008, hospitals will no longer derive additional payments they sometimes receive when Medicare patients develop 1 of the following 8 preventable complications: objects (such as surgical instruments or sponges) left in patients after surgery, hospital-acquired urinary tract infections, central line–associated bloodstream infections, administration of incompatible blood products, air embolism, patient falls, mediastinitis after cardiac …
