Med Mal News

Insurers Test Payment Methods That Encourage Cheaper Treatments

The New York Times reports that United Healthcare and Aetna, two of the nation's major health insurers, are studying whether to change their policies to reward doctors for sticking with tried-and-true ' and often cheaper ' cancer treatments. Abelson, The New York Times, 10/20/10. The insurers' pilot programs will test whether different payment incentives discourage physicians from working up individualized treatment plans for patients. The thinking is that patients ' whose bills for cancer treatment are so high already that they often have nothing to lose and everything to gain from trying experimental treatments ' are pressuring doctors to go all out in treating their illnesses. Doctors, for their part, currently receive higher fees for ordering expensive treatments. Some feel the proposed changes to the way doctors are reimbursed will help patients by making it less likely that they will undergo unnecessary and painful treatments, while others fear doctors may gain an incentive to steer patients away from treatments that could prolong their lives. Potential malpractice liability for recommending one therapy over another would depend, as always, on questions of whether the therapy ordered met with the standard of care.

Universal Protocols Have Not Ended Wrong-Site, Wrong-Patient Mistakes

The results of a study on the incidence of wrong-patient and wrong-site surgical procedures says that such “never events” (so called because they should never happen) are still occurring in large numbers, despite the imposition of hospital and surgical center protocols intended to prevent them. Stahel, Philip F., MD, et al., Wrong-Site and Wrong-Patient Procedures in the Universal Protocol Era, Arch Surg 2010 Oct;145(10):978-984. The study's authors looked at the records in one Colorado insurance database to find that, among the 6,000 doctors reporting to that system, there had been 107 wrong-site and 25 wrong-patient surgeries during the years 2002 to mid-2008. One patient died because of the mix-up, while 42 more patients suffered serious medical consequences. The upshot is this: More work needs to be done to prevent the substantial harms created by very preventable wrong-patient and wrong-site surgeries. To accomplish the goal of zero tolerance for these never events, the researchers recommend that strict adherence to the Universal Protocol be expanded to non-surgical specialties.

Insurers Test Payment Methods That Encourage Cheaper Treatments

The New York Times reports that United Healthcare and Aetna, two of the nation's major health insurers, are studying whether to change their policies to reward doctors for sticking with tried-and-true ' and often cheaper ' cancer treatments. Abelson, The New York Times, 10/20/10. The insurers' pilot programs will test whether different payment incentives discourage physicians from working up individualized treatment plans for patients. The thinking is that patients ' whose bills for cancer treatment are so high already that they often have nothing to lose and everything to gain from trying experimental treatments ' are pressuring doctors to go all out in treating their illnesses. Doctors, for their part, currently receive higher fees for ordering expensive treatments. Some feel the proposed changes to the way doctors are reimbursed will help patients by making it less likely that they will undergo unnecessary and painful treatments, while others fear doctors may gain an incentive to steer patients away from treatments that could prolong their lives. Potential malpractice liability for recommending one therapy over another would depend, as always, on questions of whether the therapy ordered met with the standard of care.

Universal Protocols Have Not Ended Wrong-Site, Wrong-Patient Mistakes

The results of a study on the incidence of wrong-patient and wrong-site surgical procedures says that such “never events” (so called because they should never happen) are still occurring in large numbers, despite the imposition of hospital and surgical center protocols intended to prevent them. Stahel, Philip F., MD, et al., Wrong-Site and Wrong-Patient Procedures in the Universal Protocol Era, Arch Surg 2010 Oct;145(10):978-984. The study's authors looked at the records in one Colorado insurance database to find that, among the 6,000 doctors reporting to that system, there had been 107 wrong-site and 25 wrong-patient surgeries during the years 2002 to mid-2008. One patient died because of the mix-up, while 42 more patients suffered serious medical consequences. The upshot is this: More work needs to be done to prevent the substantial harms created by very preventable wrong-patient and wrong-site surgeries. To accomplish the goal of zero tolerance for these never events, the researchers recommend that strict adherence to the Universal Protocol be expanded to non-surgical specialties.