Who Pays for Medical Complications?

Side note: All physicians know that it is impossible to entirely avoid medical complications. But new policies by insurance companies are muddying the line between normal complications and so-called “Never Events” – defined as “conditions that could reasonably have been prevented” if proper medical procedures had been used. The original list of “Never Events”, compiled by the Centers for Medicare and Medicaid Services (C.M.S.), included things such as operating on the wrong side of the body, or leaving surgical instruments inside of a patient. Newer lists, compiled by insurance companies, define ‘never events’ much more broadly.

Originally instituted to help lower medical costs and error rates, these ‘never event’ lists have become a new way for insurance companies to avoid paying for the cost of what are often the normal complications of surgery and other medical procedures. Additionally, this could have broad implications for medical malpractice suits. What patient, when told that a complication was so egregious an error that his/her insurance will not pay the doctor to fix it, wouldn’t assume that he or she had been a victim of medical malpractice? Wouldn’t many doctors prefer to avoid potential medical liability problems – possibly through refusing to see the sickest patients of all?

By Pauline W. Chen, M.D.
The New York Times

One afternoon during my surgical training, I received a call from an intern, a first-year doctor-in-training; she wanted me to place a central line, a specialized catheter inserted in a major vein for intravenous access. Because of the patient’s previous procedures, I would have to put his line in the subclavian vein, a vessel that courses along the top of the chest, precariously close to the lungs.

(more…)

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