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Hospitals Planning To Punish Docs Who Don’t Help Them Get Paid

Over at the WSJ Health Blog, some academic docs, such as hospitalist Dr. Wachter are suggesting just that.

Punishments such as revoking privileges for a chunk of time tend to be used for administrative infractions that cost the hospital money – things like failing to sign the discharge summaries that insurance companies require to pay the hospital bill. By contrast, hospital administrators may just shrug their shoulders when it comes to doctors who fail or refuse to follow rules like a “time out” before surgery to avoid operating on the wrong body part.

Docs and nurses who fail to follow rules about hand hygiene or patient handoffs should lose their privileges for a week, Pronovost and Wachter suggest. They recommend loss of privileges for two weeks for surgeons who who fail to perform a “time-out” before surgery or don’t mark the surgical site to prevent wrong-site surgery.

This couldn’t have come at a better time.  At Happy’s hospital there is a massive witch hunt to crack down on not signing off verbal orders within 48 hours.  This has nothing to do with patient safety.  It has everything to do with meeting the requirements of CMS  so the hospital does not lose their funding.

Not in my six years and tens of thousands of orders after six years as a hospitalist have I ever, not even once, had a patient safety issue by not signing a verbal order within 48 hours.  In fact I sign thousands of orders a year and I can’t remember the last time I actually read a verbal order that I was signing.  The volume of time required to do that would be prohibitive.  The fact of the matter is, signing off verbal orders within 48 hours isn’t a patient safety issue, especially since I don’t know a single doctor that actually reads what they are signing off on.  It’s a money issue that the CMS and JCAHO rules require in order for the hospital to get paid.

Now, hand washing?  That’s another story.  I would absolutely support any issue that actually negatively impacts patient care.  That means hand washing.  That means VTE prophylaxis. If  an issue is harming patients, and physicians refuse to comply with system processes that improve patient safety, they should be punished.

What I also find interesting, as well, is that most people reading this would also believe that physicians should be punished for failing to uphold patient safety standards.  Yet the same entitled masses would feel no obligation to punish the same patients who fail to up hold their own responsibility for lifestyles that improve healthy outcomes.  What an entitled double standard we live in.

*This blog post was originally published at A Happy Hospitalist*


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