If you want to get the attention of hospital leaders, administrators, and owners, I can’t think of a better way of doing so then hitting their bottom line.
As a Houston, Texas medical malpractice attorney, I handle cases all over the State of Texas. Over the years, I’ve been surprised to see the same type of errors happening over and over again at the same hospitals. In some cases, it seems to me that hospital decision-makers consciously choose to accept the risk of seeing patient injuries and deaths over making a real effort to improve patient safety and quality of care.
Eventually, the federal government realized that its Medicare program was on the hook to pay for additional care related to nosocomial conditions. That’s an incomprehensible phrase that patients may find in their medical records that means they have a hospital-acquired injury. I think that healthcare providers invented that phrase so they don’t have to say in plain English that they actually harmed a patient in the process of providing healthcare.
Back to Medicare. While Medicare was fine with the responsibility to pay for healthcare related to normal injuries and illnesses, it didn’t want to waste money funding additional care necessary because of injuries caused by doctors, nurses, and hospitals.
That’s why, beginning in 2016, Medicare kicked off its Hospital-Acquired Condition Reduction Program (HAC-RP). The program uses defined standards to evaluate the quality of care at accredited hospitals nationwide. Each year it assembles a list of the hospitals performing in the bottom quarter of all accredited hospitals nationwide. The hospitals in that lowest 25% are hit with a cut in the Medicare reimbursement rate, which really impacts each hospital’s bottom line.
Some famous hospitals don’t make the cut
Needless to say, this Medicare program has gotten a lot of attention. The powerful lobbyists at the American Hospital Association have complained that they don’t like the program because it’s unfair to large hospitals and teaching hospitals where medical students and residents who aren’t fully trained physicians handle a lot of the care.
While the American Hospital Association and others blame Medicare’s oversight program for the poor performance of many of the teaching hospitals who don’t make the cut, I think there’s another reason.
Houston’s Texas Medical Center is full of teaching hospitals. Houston Methodist Hospital sponsors its own residency and fellowship programs. Many of Baylor College of Medicine’s faculty, residents, and fellows work at Baylor CHI St. Luke’s Medical Center and Texas Children’s Hospital. Memorial Hermann Hospital and Children’s Memorial Hermann have faculty, residents, and fellows from UT Health Sciences Center at Houston.
I’ve handled lots of cases involving care at each of these teaching hospitals and have seen firsthand how patients can be seriously injured when attending physicians and faculty members are lax in supervising the care provided by doctors who are still in their training, including residents and fellows. Don’t get me wrong, everyone has to learn their trade or profession, including doctors. It’s just not right to use patients as guinea pigs, which is essentially what happens when inexperienced physicians aren’t adequately supervised.
For example, I’m working on a case now involving one of the major hospitals in the Texas Medical Center where a neurosurgery resident 12 days into his training—meaning 12 days out of medical school—made serious errors that led to a delayed diagnosis of my client’s slow brain hemorrhaging, which allowed it to progress into a stroke that caused serious damages.
What you can do
Just because the hospital is famous or has a big name doesn’t mean you’ll automatically get top-notch care. In fact, it may be that you’ll only interact in person with resident or fellow physicians who are still in their training. Some may only be a few days out of medical school.
The only way the teaching hospital model is safe is when it operates the way it was designed. This means that physicians in training will examine and evaluate patients and then consult with fully-trained attending physicians and faculty members about their findings and treatment plans.
As patients and family members, it’s important for you to realize how the system sometimes doesn’t work at big-name hospitals. I recommend asking your doctors, in a friendly way, what their role is at the hospital. Are they an attending physician? Are they a resident or fellow? If so, what year are they in their training?
If a resident or fellow makes treatment or discharge decisions or recommendations that you’re uncomfortable with, be sure to point out again all of the information that you think is important. If you remain dissatisfied with the explanation you’re receiving, ask or insist to see an attending physician. In my view, this is the best way to make sure you’re receiving appropriate care at a teaching hospital.