Patient Safety Reporting Proposal is All Stick, No Carrot

Years ago, a hospital for which I was working wanted some of us in the radiology department to take on new coverage responsibilities. Details were sketchy - especially pertaining to what we’d be getting in exchange for our new burdens.

The member of the hierarchy charged with presenting the proposal to us - in an effort to highlight these nebulous rewards (details about which even he probably had not been informed) - said something about there being “carrots” in it for us if we complied with the plan. Not surprisingly, implying that a group of professionals were to be corralled like a bunch of jackasses did not go over well.

What a difference a few years can make. Now, our profession receives a regular battery of sticks at the national level, and many times the closest thing to a carrot we see is the absence of another stick. For instance, a new regulation is imposed with the “carrot” that compliance means your reimbursements won’t be cut next year.

The latest anti-physician stick offered up by the current White House administration is a “consumer reporting system for patient safety.” Patients and their relatives are to report via website and/or phone whenever they think a medical error (or even a near miss) has occurred, and why the patient/relative thinks it happened. According to an article in The New York Times, questionnaire options offered are:

• A doctor, nurse or other health care provider did not communicate well with the patient or the patient’s family.

• A health care provider didn’t respect the patient’s race, language or culture.

• A health care provider didn’t seem to care about the patient.

• A health care provider was too busy.

• A health care provider didn’t spend enough time with the patient.

• Health care providers failed to work together.

• Health care providers were not aware of care received someplace else.

Notice that EVERY SINGLE CHOICE lays the blame squarely at the feet of a health care provider. It can’t be, for instance, that the patient was noncompliant with his meds or failed to show for a follow-up appointment. It can’t be that an insurance company (or Medicare) blocked the provider’s diagnostic or therapeutic plan of action.

Notice, too, that this initiative provides no new service to the health care field. We already have a robust med-mal industry, and peer-review programs are virtually required to maintain licensure and credentialing as it is. Do we really need another government program for this? With the unspoken threat that this initiative will keep tabs on those running afoul of the system? Perhaps lists of such miscreants will be available for purchase by local ambulance-chasers, as a “public service.” Heck, maybe those lists will be given freely - the current admin is clearly friendly with the med-mal folks, given the complete lack of meaningful tort-reform efforts during the past four years.

How is it that no such initiatives have been launched on behalf of the besieged health care workers? Where is our hotline to report instances in which our jobs are made difficult (or impossible) by the morass of our current system? Wouldn’t it make sense to get input from the intelligent professionals who are dealing with it day after day?

It might REALLY have made sense to get some of that input while writing up 2,800 pages of open-ended new rules for the system. Assuming our opinions were actually wanted and/or respected on the matter. Then again, you generally don’t want your beasts of burden having a say in which way the plow gets pulled.