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Gawande: Hospitals Profit When Surgeries Go Wrong

Cheryl Clark, for HealthLeaders Media, April 17, 2013

She says it should be seen as "a call to action for purchasers to get to the negotiating table. You must realign these incentives."

Gawande says that major private insurer incentives such as bundled payments are "the direction we have to go."

For example, he says, "when you see Walmart cutting a deal with hospitals like the Cleveland Clinic, where for a certain operation [Walmart] gets a guaranteed price regardless of the number of procedures or whether there are complications, this is a real shot across the bow. It's a signal to other hospitals that this is something that's going to be asked of them."

"It's a very big cultural shift for medicine to adopt these things," he says.

Certainly hospitals have become safer, especially in the last several years as reporting on Hospital Compare and other efforts have raised awareness, Gawande acknowledges.

"I'll be the first to tell you that there has been substantial improvement that has happened. Death rates, for example, have fallen.

"But if you compare what we really should have as quality control measures, we have known programs that cut death rates from anywhere from 15% to 50%. Those should be norms throughout the healthcare system.

"Instead they're only present in a minority of hospitals. And all of our studies find that we can go in and implement multiple protocols that cut death rates at those kinds of magnitudes, but the puzzle is, why hasn't that spread throughout the system?"


Cheryl Clark is senior quality editor and California correspondent for HealthLeaders Media. She is a member of the Association of Health Care Journalists.
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4 comments on "Gawande: Hospitals Profit When Surgeries Go Wrong"


16788044 (4/18/2013 at 12:37 PM)
No kidding, the doctor has to do more work because of a complication and additional revenue is generated, who would have thought. Why is this article is printed, it doesn't take a genius to see this risk. So what's the solution, all procedures have to be taped and review to ensure doctors are not be unethical. Come on, this risk has always been there and always will be. Are there doctors that take advantage of this, yes, and again, there always will be. Do the vast majority of doctors have the ethical sense not to do this, yes, and they always will.

Naomi Price (4/17/2013 at 7:52 PM)
What a cascade of horrors. It's good that your surgeon has been kind and compassionate and that your hospital at least apologized. However, it's impossible to know from your comment, at least, the source of the infection. It could trace to the surgeon. Or not. I do hope you continue to improve and that your knee replacement goes well. As for "paperwork" interfering with safety, what kind of paperwork interferes with hand hygiene? With use of surgical checklists, each and every time? With CLABSI prevention protocols? With attention to environmental cleaning? With pre-surgery MRSA screening & education of patients? With VTE & DVT protocols? This study dealt solely with surgical/post-surgical care, nothing else.

Tara Bukowsky (4/17/2013 at 12:12 PM)
Approximately a year and a half ago, I underwent a simple knee arthroscopy for a torn medial meniscus at Cox Walnut Lawn in Springfield, Mo. Following surgery, I developed a severe enterococcus hospital acquired infection deep in the joint resulting in septic arthritis. Five additional surgeries, 2 inpatient hospitalizations, drains, a picc line, seven weeks of IV antibiotics, a DVT, Lovenex injections, home health nursing and months of lab draws were required to treat the infection. I lost my job and my health care coverage as a result of this ordeal. The hospital billed my insurance company (that I had at the time), then balance billed me. My surgeon, who I feel was not responsible for this infection in any way not only saved my life, but remained compassionate and supportive throughout this entire ordeal. I do feel though that the hospital was responsible, but they feel differently and have offered an apology for the immense physical, emotional and financial strain this has placed on me and on my husband. I have remained under care, still unable to work and now require a total knee replacement. The hospital could have responded to my repeated requests to assist with some of the financial burden, but said I was a "statistic" and they felt that I had not received improper care. My care was appropriate for the circumstance, but was required due to an event that should never have occured in the first place.