After reading all your links and doing some thinking, this all comes down to how you interpret some of the data.
Do hospitals bill for services to patients for injuries or harm that has come to them as the result of facility error? Yes. Does the compensation the hospitals receive cover all the expenses? No. That's the real story behind all of this.
The reason for "creative billing" comes down to reimbursement insufficiencies across the board. The average hospital takes a real beating when it comes to collecting payment from insurance companies or the state. Why do you think there are so many fundraisers for these facilities all the time? And if your local hospitals are anything like the ones down here, you probably get letters from them asking for donations at least once a year.
When I worked for Children's, I was surprised to find out how poor the reimbursement rates were. We'd never turn anyone away based on their inability to pay for services, but the money lost because the state or insurance wouldn't or couldn't adequately cover all the charges meant that staffing was reduced, supplies weren't well-stocked, and the quality of care was compromised (thus increasing the likelihood of hospital error).
I saw this at other hospitals, too, but it really hit home at Children's, where I had patients from every walk of life, from around the world.
Perhaps the best example of "competitive" care services is another hospital I worked for: with patients coming from Mexico (for prenatal and labor & delivery care), the doctors offered deep discounts if the families paid cash -- which they did. By securing the funds up front, they were guaranteed payment. We don't get that guarantee with insurance companies or state funds. Any patient wishing to pay in cash received these discounts and the hospital became the go-to center for care amongst savvy patients.
While none of this excuses poor sterilization practices or carelessness in any healthcare setting, I do understand the billing aspect all too well. And regarding those instances of preventable injury and/or death due to substandard sterilization, facility maintenance, or staff neglect/awareness, that's where JCAHO needs to step in and start raking these institutions over the coals. Every patient has the right to quality care and has the right to expect that certain standards and practices are met at all times.
I abhor fraud. I abhor the bureacracy that ties the hands of people wanting to good. I abhor those who don't care enough to do their jobs the right way, including following stringent controls that safeguard against injury. But I understand the billing issues. Sad, isn't it?
I hope that made sense. I could reread that 14 times and still question it.
Thanks for your comments, Goddess... It took me about a year before I began to accept what physicians and nurses were telling me. Check it out and let me know what you think... cb
As a nurse, I have gone through several orientations and have been through all those "whistleblower hotline" lectures. Every hospital has a hotline and you do not have to leave your name in most cases. I've also watched the videos about cases where the hospital's mistake has cost someone their life or has harmed them. Let me tell you, hospitals take this very seriously.
I can't see how hospitals could possibly profit from deadly mistakes -- it costs so much for them to settle with the families, retrain staff, and implement new guidelines to prevent errors in the future -- but I will read all your links and try to wrap my head around it.
Lots to read and think about, for sure.
Commenting by HaloScan
