Gawande: Hospitals Profit When Surgeries Go Wrong

Medical complications in surgical patients generate profits for hospitals, a study led by Atul Gawande, MD, shows. But the American Hospital Association disputes the report's implications that hospitals aren't incentivized to avoid complications.

4 comments on "Gawande: Hospitals Profit When Surgeries Go Wrong"
16788044 (4/18/2013 at 12:37 PM)

No kidding, the doctor has to do more work because of a complication and additional revenue is generated, who would have thought. Why is this article is printed, it doesn't take a genius to see this risk. So what's the solution, all procedures have to be taped and review to ensure doctors are not be unethical. Come on, this risk has always been there and always will be. Are there doctors that take advantage of this, yes, and again, there always will be. Do the vast majority of doctors have the ethical sense not to do this, yes, and they always will.
Naomi Price (4/17/2013 at 7:52 PM)

What a cascade of horrors. It's good that your surgeon has been kind and compassionate and that your hospital at least apologized. However, it's impossible to know from your comment, at least, the source of the infection. It could trace to the surgeon. Or not. I do hope you continue to improve and that your knee replacement goes well. As for "paperwork" interfering with safety, what kind of paperwork interferes with hand hygiene? With use of surgical checklists, each and every time? With CLABSI prevention protocols? With attention to environmental cleaning? With pre-surgery MRSA screening & education of patients? With VTE & DVT protocols? This study dealt solely with surgical/post-surgical care, nothing else.
Tara Bukowsky (4/17/2013 at 12:12 PM)

Approximately a year and a half ago, I underwent a simple knee arthroscopy for a torn medial meniscus at Cox Walnut Lawn in Springfield, Mo. Following surgery, I developed a severe enterococcus hospital acquired infection deep in the joint resulting in septic arthritis. Five additional surgeries, 2 inpatient hospitalizations, drains, a picc line, seven weeks of IV antibiotics, a DVT, Lovenex injections, home health nursing and months of lab draws were required to treat the infection. I lost my job and my health care coverage as a result of this ordeal. The hospital billed my insurance company (that I had at the time), then balance billed me. My surgeon, who I feel was not responsible for this infection in any way not only saved my life, but remained compassionate and supportive throughout this entire ordeal. I do feel though that the hospital was responsible, but they feel differently and have offered an apology for the immense physical, emotional and financial strain this has placed on me and on my husband. I have remained under care, still unable to work and now require a total knee replacement. The hospital could have responded to my repeated requests to assist with some of the financial burden, but said I was a "statistic" and they felt that I had not received improper care. My care was appropriate for the circumstance, but was required due to an event that should never have occured in the first place.
Bruce Landes, MD (4/17/2013 at 10:44 AM)

1. The Dallas Morning News this morning identified the hospital system as Texas Health Resources, which operates throughout the DFW Metroplex. The article states that this new transparency is part of an effort by THR to become nationally recognized for quality of care. 2. It should be noted that payment to doctors for procedures, especially surgery, is already a global fee which covers follow-up and complications by having a "global period" following the procedure (usually 60-90 days) covering all follow-up care related to the surgery. Doctors are already financially motivated to avoid complications. 3. "...our studies find that we can go in and implement multiple protocols that cut death rates at those kinds of magnitudes, but the puzzle is, why hasn't that spread throughout the system?" Why isn't quality spreading through the system? Possibly because it takes a ten-page pamphlet to even define all of the acronym-laced programs foist upon the hospitals (and physicians) by well-intentioned government fiats that increase costs and compliance issues in their attempt to impose a one-size-fits-all solution to controlling costs and improving quality. As a physician and president of a not-for-profit IPA that assists practitioners in coping with the myriad new and old government regulations, which are rife with examples of the Law of Unintended Consequences, I am constantly reminded of this phrase from the list of complaints against King George III in the Declaration of Independence: "He has erected a multitude of New Offices, and sent hither swarms of Officers to harass our people, and eat out their substance."


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