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A Halloween Tale Of Medical Travail

Posted by J. Paul Spencer, CPC, CPC-H in Electronic Health Records, Hot Topics, J. Paul Spencer, CPC CPC-H

“The barren trees of late Autumn, as if sketched against the sunset sky with a piece of charcoal, tapped in the wind against the windows of an operating room at Rhode Island Hospital. A patient was being wheeled away as a surgical technician wondered why there was one less drill bit in the OR than before…”

Rather than being the beginnings of an Agatha Christie mystery or yet another book by H. P. Lovecraft about reanimating the dead, what you have just read is the beginning of a story that led this week to the imposition of a $300,000 fine against Rhode Island Hospital. The missing drill bit was discovered to have been left in the patient’s head during brain tumor surgery. One wonders if this was discovered because the patient’s head kept pointing to Magnetic North, as the hospital didn’t follow an internal protocol of performing a postoperative x-ray in the OR when it is discovered that a surgical instrument is missing. Shortly after this incident, the same hospital had a similar incident involving a pair of forceps being left inside a patient’s abdomen.

While the above story is newsworthy, we have come to realize that medical mistakes have become problems that require increased attention. In an earlier posting in this space, I talked about steps taken in this year’s OIG Work Plan towards determining whether the quality of care provided is deserving of Medicare reimbursement. This goes hand in hand with fairly recent CMS efforts to eliminate payments to hospitals for “never events” and hospital acquired conditions. The two examples above topped a list of these occurrences first implemented in 2008 and which continues to expand.

As Rhode Island Hospital so unceremoniously discovered, having protocols in place is not the problem-solving panacea to adverse patient care events in a health care setting.  Incidents like the one above shed light on the inherent problems of this approach, not the least of which is that human beings are still the predominant providers of medical care. Given this fact, we tend to look for better, less spooky paths to improved outcomes.

With the current Halloween candy-like incentives being offered for implementing an electronic health record (EHR), the medical community seeks news of a positive return on this particular investment. Yesterday, CompTIA, an information technology trade group, released a study that gives a snapshot of EHR adoption. The study showed that roughly 50% of all physicians are using either a complete or partial EHR in their practices, which is a heartening figure given that the incentive payment period begins in 2011. Due to its source, the report included no news of how EHR adoption is affecting patient care. While some preliminary studies have yielded results showing that an EHR can be of great assistance toward favorable patient outcomes, the medical world awaits a larger volume of hard data to show this beyond a shadow of a doubt.

Another horrific element of the equation are the many different conceptions of “quality care” held by the patients themselves which become the great intangible in this debate. On one end of the scale is a person like me, who sees his doctor either once a year or in cases of abnormal bodily processes that I myself am unable to stop. The opposite end of the patient care spectrum is the malingering patient who looks forward to further testing for nothing in particular. In cases like this, can it be accurately determined whether a poor outcome is a patient’s frightening perception or the cold, skeletal deathly hand of harsh reality? 

Of all the ghastly and gruesome stops along the road to improved outcomes, medical providers are about to find that worst among these is declining reimbursement for care determined to be avoidable or unnecessary. As Rhode Island Hospital discovered this week, the path to providing consistent and quality care requires continuing effort and eternal vigilence against the dark forces who pay for care, but cheer up. In the end, the road is not half as scary as the effect of this on the world of acting. Now that’s terrifying!