There Is Such a Thing as Being Too Careful

According to The New York Times, Medicare may be punishing hospitals—and academic medical centers (AMCs) in particular—for being too careful.  That’s how Northwestern Memorial Hospital’s chief medical officer sees the practical effect of Medicare’s policy of reducing payments to the hospitals with the highest rates of infections acquired after admission, blood clots after surgery, and other complications that Medicare regards as avoidable.

The article, produced in collaboration with Kaiser Health News, suggests that the policy is skewed against AMCs in two ways.  First, AMCs tend to see the sickest of the sick, and those patients are more prone to complications than the average patient.  Second, AMCs tend to be more cautious than other hospitals, ordering more tests and therefore discovering more complications.

The statistics appear to bear out this position.  Nearly half of the country’s 758 AMCs are being penalized this year, including such blue chip institutions as Northwestern, Stanford, and the Cleveland Clinic.  And the penalties are severe: one percent of Medicare payments.  For Northwestern, that’s $1.6 million.

Critics of the policy cite several other problems, in addition to the unfair burden on AMCs.  First, there’s the bounty-like aspect of the policy that requires that a quarter of all hospitals be penalized each year.  Second, it creates a temptation to over-test at the time of admission, in order to prove that infections weren’t hospital-acquired.   Third, the policy punishes hospitals for being scrupulous in identifying and reporting complications.

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