Through me the way into the suffering city,
Through me the way to the eternal pain,
Through me the way that runs among the lost.
Justice urged on my high artificer;
My maker was divine authority,
The highest wisdom, and the primal love.
Before me nothing but eternal things were made,
And I endure eternally.
Abandon every hope, ye who enter here
---- Dante
Hospital cited for a number of preventable deaths
Should low quality hopsitals be given more or less money?
August 25, 2008 in Hospitals, Medicaid/Medicare, Quality
Recently, the San Diego Union Tribune re****ted that the Sharp
Grossmont Hospital in eastern San Diego county was cited for a number
of preventable deaths. Re****ter Cherl Clark found numerous problems,
which included:
=93staff members restraining a highly medicated, 25-year-old man with
schizophrenia in such a way that he was allowed to suffocate. In
addition, hospital workers caused the death of an 83-year-old woman
who had undergone a hysterectomy by injecting a dangerous anti-
narcotic into her bloodstream. Other problems included nurses who did
not know or use proper CPR, an unsanitary operating-room mattress held
together by tape and glue, unsafe storage and handling of food and
kitchen equipment, and use of critical medications such as heparin
that had expired up to a year earlier.=94
CMS is threatening Sharp Grossmont that it could lose all federal
money (i.e., Medicare and Medicaid). Since 50% of Sharp Grossmont=92s
business comes from Medicare and Medicaid patient, this would be a
disaster for the hospital. What should we do with underpreforming
hospitals?
In regular markets, when a product has lower quality, people stop
buying that product and switch to another one. For instance, if GM
stops making high quality cars, people switch to Toyota. The market
compels companies to offer a desirable bundle of quality and price or
else they will lose business. Because markets are so effective at
maintaining high quality, withholding Medicare and Medicaid payments
from Sharp Grossmont makes sense, right?
Maybe not in this case. First of all, some hospitals may not be in a
competitive market. While urban hospitals must compete with other,
nearby hospitals, Sharp Grossmont is supposed to provide medical care
for the entire Grossmont Healthcare District, which covers 750 square
miles in San Diego=92s more suburban and rural East County. This area
has more than 652,000 residents and Sharp Grossmont has the busiest
emergency department in San Diego County. By reducing funding,
individuals who have emergencies will receive even worse care than
before.
This is similar to the no child life behind program. Low preforming
schools lose money. But these are exactly the schools that need more
money to survive. If students had the freedom to switch schools, then
penalizing a failing school would make perfect sense since the
students could opt for higher quality schools. The failure of low
quality schools would not be a problem if students had other schools
available for them to choose to attend. If individuals do not have any
choice of which school they attend, however, withholding funding from
schools or hospitals can make low quality schools worse.
Will Sharp Grossmont be decertified? The CMS threat to withhold
funding is likely just a bluff.
=93Among the 450 hospitals in [CMS certification officer Steven]
Chickering=92s jurisdiction of Hawaii, California, Nevada and Arizona,
10 to 12 a year have as many major lapses, he said. Ninety-nine
percent of those facilities resolve their crises and keep their
federal payments, Chickering said.=94
The federal government knows that removing funding from the only
emergency room in a 750 square mile area is not politically feasible.
Although individuals may not have much choice of a hospital in an
emergency situation, in non-emergency situations patients can decide
to drive longer distances to visit physicians at more competent
hospitals. If CMS payments are pro****tional to patient volume, then
Sharp Grossmont may take a financial hit due to this lower patient
volume without having the hospital decertified.
Decertification is likely not the answer, but having such serious
quality lapses reflects poorly on the state of health care in San
Diego, and in the U.S. in general.
Additional information on Sharp Grossmont=92s predicament can be found
at KPBS=92s the Editors Roundtable.
http://healthcare-economist.com/2008/08/25/should-low-quality-hopsitals-be-=
given-more-or-less-money/
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