Photo by Flicker member AndyI used with permission

In the interest of "protecting patient safety," the Massachusetts Department of Health and Human Services has selected 28 "serious reportable events" that it will not pay for or allow hospitals to bill them for. These include surgery on the wrong body part or patient, performance of the wrong surgery, retention of a foreign object after surgery, and even death! Other nonpayable events include discharging an infant to the wrong person, patient suicide, disability stemming from medication errors, and more. Officials are trying to pass this off as a way to "improve" patient health and safety, but we don't think mere nonpayment is enough to accomplish this goal.

By not paying for botched care, the state does send a message that medical mistakes are unacceptable--but it doesn't actually do anything to prevent malpractice, or give hospitals the resources they need to improve their services. It's possible that the threat of nonpayment will motivate individual hospitals to take steps toward preventing mistakes. Still, it seems to us that other steps--like implementing stringent guidelines that would help avert common problems, firing inept doctors and nurses, creating criteria to close down departments with too many mistakes, and making it easier for practitioners to do their jobs better--would be more likely to help patients in the end.

This feels sort of like the practice of reducing funding for failing schools. If an institution is already struggling, will giving it less money help it improve in any way? If you're unable to pay your rent, will a salary decrease help you out? The answers are no and no, and we expect that this new nonpayment policy will be similarly ineffective--despite all the time and money it probably cost to come up with and will still cost to implement.

To sum up, those of us with private insurance could feasibly get the wrong leg cut off and still have to foot (har har) the bill, but the state insured can relax in the knowledge that nobody will get paid if their surgery is botched. Comforting! Medicaid Director Tom Dehner made the important assertion that "state purchasers will not pay for egregious medical errors," but neglected to mention that private citizens can still get screwed. So let's hear it for two of our favorite useless things: government and health insurance! Hip hip (surgery) hooray!