Rx4PA: House Bill 2098 would do for Pennsylvania what Medicare has done for everyone

The Pennsylvania AFL-CIO is pressing legislators to pass HB 2098, a bill submitted on December 6th and sitting before the House Insurance Committee (authored by its chair, Rep. DeLuca). We were all a little disappointed earlier this year when the legislative process failed to make good on Governor Rendell's plan to allow our insurers to quit paying for infections and mistakes made by Hospitals. Then, the next thing we knew, Medicare (by far the biggest spender in Healthcare) came along and said it wasn't going to pay for those mistakes or infections starting late in 2008, anyway. Which could have nearly the same effect, so HB 2098 seeks to give our Pennsylvania insurers that same right: to refuse to pay bills for procedures correcting conditions that hospitals should have prevented.

"But wait! I thought we already solved this problem?" you ask. Sure you do. We did something about it, but we sure didn't solve it. In fact, in one very important way, we took a step backward. A big step. Click Read More to see what I mean!

When Senate Bill 968 passed the legislature earlier this year, many people viewed it and lauded it as a real success for controlling one of the major costs for driving up insurance premiums: preventable mistakes made by surgeons and other doctors under too much pressure to run patients through at high speed.

A part of that story got left out, though. While it's true that SB 968 created an incentive for hospitals to step up their error control, the Hospitals also effectively pulled off an end-run around one of the shining lights of Pennsylvania's Healthcare System, the Hospital Cost Containment Council [HC4]. Our state was seen as trailblazer for requiring hospitals to report patient errors (and a load of other information, including the price of procedures) on a case-by-case to a single, transparent body that could provide policymakers the information they needed to correct poor performance in hospitals exhibiting it.

Under SB 968, HC4 has been shut out of the process. Instead, error and infection data will be reported to the Center for Disease Control [CDC], a Federal agency prohibited by law from sharing case-specific or hospital specific data with anyone, even an Agency like HC4. We just have to trust the CDC to take care of business if something is way wrong.

Does that sound good to you? We're YPP, so I already know the answer. We're freaking transparency junkies here.

So, given the political momentum created by Medicare's forward-thinking decision, the AFL-CIO seems to be looking to seal the deal with HB 2098. If we can't have transparency then, fine, we'll do you one better: we just won't pay for the bad stuff. The idea, I imagine, is this: hospitals are going to have to clean up their act anyway to prevent writing off mistakes they would have had to charge to Medicare, so we might as well make absolutely sure the same benefits accrue to the insurers covering PA workers.

Which means Blue Cross and Blue Shield of PA can make absolutely sure it is not paying for mistakes. Which means the cost of insurance across the board should drop. Which means Cover All Pennsylvanians will be more affordable still. Which means we ought to just pass HB 2098 and get an affordable, high-quality healthcare plan for uninsured workers and families while we're at it.

Presently, HB 1137 is in the Speaker's Office, waiting for a hearing on the House Floor. If this gets through the General Assembly, all we've assured is a debate about Cover All Pennsylvanians. That would be good, but it would be nice to get the whole deal done.

HB 2098 might make it slightly more likely. Everyone wins.
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The Philadelphia Unemployment Project
This Too Will Pass

Article on Prevention

Atul Gawande has a really interesting article on how some really simple steps in hospitals (for example, using a checklist in an ICU), can save lives and save millions of dollars.

exactly

that's what everyone has said from the beginning... it's as simple as just taking some precautions. Nothing fancy. Docs are under too much pressure and the details are slipping and details matter when you're dealing with microbes, you know?

---
This Too Will Pass, treating grave matters lightly and light matters gravely, since 2001.

Speaking of Blogger Self-Promotion

Atul Gawande is my hero. Back in May, I wrote this on my other blog:

Atul Gawande strikes me as something like a protagonist out of a 19th-century play or novel: the intelligent, humane physician/scientist, as articulate as he is perceptive, slowly fighting to unearth the hidden dangers, to expose injustice, and to educate and cure what ails the body politic.

--Tim (aka Short Schrift)

The NYT Has a Point on the Doctors

I think the New York Times piece listed in the article has a good point. We need to extend the refusal to pay to doctors who demonstrably screw up.

I think doctors are often given an easy break. True, some doctors are genuinely compassionate life-savers, but, let's face it, some are greedy, incompetent jerks who put their own bottom line in front of patient care and safety. Trust me, I've encountered a few.

The Expatriate

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