"If you think that hospitals are somehow differentiating by payer, that would be odd," she says. "And it's clear to me that when hospitals prevent these complications, they do have a financial incentive to do so," not the other way around.
Besides, she says, every hospital in the country is dedicated to patient safety at some level. "We haven't gotten to perfection yet, much as we would like to get there. But we are dedicated to making patient care safe regardless of the consequences to the bottom line."
To suggest that hospitals are not trying to improve safety because their financial incentives direct the opposite, she says, "is disingenuous" by Gawande and his co-authors.
But Leah Binder, president of The Leapfrog Group, which represents employers that purchase health coverage, says Gawande's report illustrates profits from complications "that are outrageous− an example of cost-shifting to purchasers that is senseless."
She says it should be a "wake-up call" to employers that "you are being taken by the hospital community, that you are paying almost $40,000 more every time a hospital makes an error during surgery" with a covered worker.
"These numbers tell us there's profit to be made in suffering. Whether hospitals are deliberately taking advantage of this opportunity or whether they just happen to benefit from it is irrelevant."
Binder adds, "In what other industry do you pay more because they're worse? Do you pay a restaurant more because they have a rat infestation? No. I don't care whose fault it is. The numbers in this paper are astonishing."