Paper Example: Healthcare Delivery and Quality Case Study

Why Insurance Companies Should not Pay for Injuries and
Readmissions

Medical errors and readmissions in hospitals cost the insurance companies a lot of money. For example, the study “Crossing the Quality Chasm” (2001) revealed that medical errors cause a lot of deaths and also cost funds amounting to $29 billion on a yearly basis. This is a huge burden to the insurance that pays for these costs. The hard bit is that these conditions can be prevented if hospitals become more careful when treating patients. Thus, insurance companies should not pay for injuries, medical errors, and other costs that arise from the negligence of the hospital staff.

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It is essential to note that going to a hospital brings risk since one could get a hospital-acquired infection (HAI) or become a victim of medical errors. The burden imposed on insurance companies for preventable conditions is very huge. Since hospitals have an easy way of passing on the burden of payment for such cases, they are never keen on improving conditions (Becher & Chassin, 2001). However, if insurance companies were never to pay for injuries and readmissions, hospitals would be more careful in their operations.

Margaret Spinner-Ramirez’s case is an indication of how negligence in hospitals may overburden the patient. For example, after her left knee replacement, she was readmitted to the hospital where her left leg was infected and this was not as a result of the cat scratch. As a result, she needs to have a second left knee replacement surgery. Such extra costs arising from medical errors should not be passed on to the insurance companies. Hospitals need to cover the costs arising from their errors.

Two Ways/ Initiatives Healthcare Quality Can Be Improved to Reduce Errors and Improve Patient Safety

Medical errors harm a great number of people in America every year (Mosadeghrad & Woldemichael, 2018). To address this, there is a need to have initiatives that are aimed at reducing errors and improving patient safety. One of the ways to improve healthcare quality is by addressing the way health care professionals are trained. The curriculum must be adjusted to train health care professionals on how to avoid medical errors. With proper and thorough training, there is the likelihood that the high cases of medical errors could be reduced significantly.

The second way is by improving the effectiveness of the disciplinary procedures by holding into accountable healthcare practitioners who make serious errors repeatedly. The disciplinary procedures should anticipate serious actions against such health care practitioners, including legal actions, to compel them to pay for the damages and have their licenses revoked (Mosadeghrad & Woldemichael, 2018). Such stern actions will lower go a long way in reducing the cases of medical errors and improve patient quality.

How Creating Incentives for Providers Can Improve Quality and Reimbursements

Creating incentives for providers can improve quality and reimbursements to a great extent. Hospital incentives for investing in patient safety may differ from one payer to another as well as payment configuration. It is imperative to note that higher payments provide resources as a means of improving patient safety. Better incentives may also increase the willingness of hospitals to invest in patient safety.

One of the steps that were taken by the US government is to introduce pay for performance. This was introduced as a means of incentivizing hospital investment in quality initiatives, which are essential in the improvement of patient outcomes (Studdert, 2007). Cost resulting from medical errors should be offset by the hospitals. However, cost burdens of lower-quality care need to be shared among different parties such as the providers and payers.

Reforms such as rewarding hospitals that institute better safety standards could be viable incentives to improve patient outcomes in the hospitals. Some insurance companies have advised hospitals that they will never be covering for “never events,” such as performance of surgery on the wrong body part. This will make hospitals more careful and keener in their operations.

Financial penalties may be instituted to hospitals that record the highest cases of hospital-associated infections (HAIs) so that they can improve on their performance (Bhattacharyya, 2014). Such penalties may inform the hospital to improve on their services to reduce the number of HAIs and patient outcomes. Hospitals must be compelled to provide the best care possible to the patients to reduce HAIs and readmissions.

For example, the case of Ramirez shows some negligence on the part of the hospital. The CT scan and blood work conducted on her after being taken back to the hospital revealed that her knee replacement in her left leg was infected secondary to the cat scratch. To avoid such cases and reduce the burden passed on to insurance companies, hospitals should be made to pay for their errors. Such a practice would ensure that hospitals develop internal incentive mechanisms to the health care providers to ensure that there is an improved health care outcome. Besides, this would go a long way towards ensuring that patient safety is enhanced.

References

Becher, E. C., & Chassin, M. R. (2001). Improving quality, minimizing error: Making it happen. Health Affairs, 20, 3, 68-81. https://www.healthaffairs.org/doi/full/10.1377/hlthaff.20.3.68Bhattacharyya, D. K. (2014). Evidence-based HR-mediated innovative quality management practices.

https://www.igi-global.com/chapter/evidence-based-hr-mediated-innovative-quality-management-practices/96670Institute of Medicine (U.S.), & National Academies Press. (2001). Richard and Hinda Rosenthal Lectures Spring 2001: Crossing the quality chasm.

https://www.nap.edu/catalog/10847/the-richard-and-hinda-rosenthal-lectures-spring-2001-crossingMosadeghrad, A. M., & Woldemichael, A. M. (2018, January 01). Application of Quality Management in Promoting Patient Safety and Preventing Medical Errors. https://www.ncbi.nlm.nih.gov/books/NBK2682/

Studdert, D. M., (2007). Who pays for medical errors? An analysis of adverse event costs, the medical liability system, and incentives for patient safety improvement. Journal of Empirical Legal Studies, 4, (4), 835-860. https://www.commonwealthfund.org/publications/journal-article/2008/apr/who-pays-medical-errors-analysis-adverse-event-costs-medical