Articles Tagged with “medical errors”

Important Questions After New York Man Was Forced to Pay $117,000 for Last-Minute Surgeon He Never Met

20140924_medicalbilling.jpgIt is hard enough to be in pain and need surgery. But it gets much worse if you are unfairly billed huge sums from doctors you never met and never knew would be “helping.”

The New York Times recently shared the story of a New York City man who received an unexpected $117,000 bill after a neck surgery. The story did not have a fair ending; the man had to pay the bill, though the reimbursement came from his health insurance company.

Peter Drier had done careful research on the costs before his surgery at a Manhattan hospital and thought he knew what to expect. But the bank technology manager was blindsided when he received a $117,000 bill for an assistant surgeon he had never met or knew was involved in his care. Before surgery, Drier’s primary surgeon, Dr. Nathaniel L. Tindel, had agreed to accept a negotiated fee determined by his insurance company, about $6,200. Drier had to pay $3,000 toward this as part of his health insurance deductible. But Drier was never informed about the assistant surgeon, Dr. Harrison T. Mu, who was outside of his insurance company’s network of covered providers, until after he was home and received the bill.

The primary surgeon’s office said he did not share in the billing and the assistant surgeon never responded to The New York Times. Drier questioned the charge, and at the same time argued with his insurance company to make the payment. They resisted the “out of network” charge, but eventually paid it, even though by now the patient was protesting the entire unfairness of the situation.

“I thought I understood the risks,” Mr. Drier told The New York Times. “But this was just so wrong — I had no choice and no negotiating power.”

The New York Times recently reported on the growing practice of consumers being charged for out of network doctors in many instances, even hospital emergency rooms, and later receiving unexpected bills. This is significant because an out of network physician can charge 20 to 40 times as much as an in network doctor and costs are not covered by health insurance. For example, an out of network doctor charges an average of $115,625 for a spinal fusion in the U.S., while an in network physician charges an average of $5,983, according to figures cited by the newspaper.

How Massachusetts Consumers Can Protect Themselves From Unexpected Charges
New York will implement a new law next March, which in part will require more advance disclosure of medical costs and seek to protect patients from unforeseen out of network fees. Hospitals and insurers will be directed to mediate and negotiate cases from there.

Massachusetts is also making changes. In 2012, the state passed a health care cost containment law, which called for patients to have access to medical costs before a procedure or care is delivered.

  • As of October 2013, health insurers have been required to provide information on cost estimates for office visits to physicians and specific tests and procedures. For the first year, insurers had two working days to provide the information. Starting October 1, 2014, they will be required to provide the information instantaneously. Consumers are expected to be able to search pricing online themselves.
  • As of January 1, 2014, hospitals and physicians also have to provide cost estimates.

What to request:

  • Under the law, your doctor or health care provider must disclose the “allowed amount” or charge of admission, procedure or service, including the amount of any “facility fees.” The allowed amount is the contractually agreed amount paid by a carrier to your health care insurer. The most important thing is to make sure you understand what your insurance company must pay and what you must pay for a deductible. If that is not written down for you clearly, ask questions – and keep asking questions until you have something in writing you understand.
  • They should provide you with CPT codes, or the billing codes.
  • As for out of network costs, the law also compels providers who participate in networks to provide sufficient information about the proposed procedure or service to allow a patient to use the network’s toll-free number and website to disclose the costs.

The key is that patients must request this information. Start by making sure you understand exactly what your medical treatment will include. Doctors may order panels of test for which expenses add up quickly; you may wish to control the extent of treatment being offered depending on its cost.

We suggest you take time over the next few months and become comfortable with the system before you have a medical crisis. Start by contacting your health insurer and asking for an estimate for your next medical appointment. Contact your physician’s office or hospital as well and compare the findings. Also, ask your health insurer what pricing information is available online too but do not rely on it until you learn about the system.

Be a wise consumer! Do not step into a doctor’s office until you have reached agreement on the price, what your health insurer will pay, and how much you will pay for your deductible.

After Surgery, Surprise $117,000 Medical Bill from Doctor He Didn’t Know, The New York Times.

Medical Price Transparency Law Rolls Out: Physicians Must Help Patients Estimate Costs, Massachusetts Medical Society Blog

Massachusetts Office of Consumer Affairs and Business Regulation Infographic

Many unaware of new rules on health care costs, The Boston Globe.

Breakstone, White & Gluck consumer safety articles
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doctor-patient-2014.jpgDespite years of patient safety initiatives, reports of serious medical errors at Massachusetts hospitals are rising rapidly.

In 2013, Massachusetts acute-care hospitals reported 753 serious medical errors and other patient injuries, according to The Boston Globe. This was an alarming 70 percent increase from the previous year. Other hospitals, including those providing psychiatric and rehabilitative care, saw a 60 percent increase from 2012.

Some say the reason may be broader reporting requirements from the state. Since 2008, hospitals have been required to notify the state Department of Public Health about serious reportable events. In addition, the Department of Public Health now has a computerized system for reporting, a change from when medical errors were reported by fax.

In the past, hospitals had to report incidents which left a patient with a “serious disability.”
In 2012, the term became “serious injury” and it has new categories, including if a patient dies or suffers serious injury if a medical professional fails to communicate test results.

State officials say the new requirements have been fully implemented. That means the conversation should move on to safety and preventing medical malpractice.

There were very serious injuries reported in 2013 and these are the areas which saw the largest increases:

  • Patients who underwent a procedure on the wrong body part
  • Patients who were burned in an operative room fire or by a heating pack
  • Patients who were exposed to contaminated drugs or improperly sterilized equipment

Massachusetts is working to reform medical malpractice along with many other states and the federal government. In 2012, the state passed a health care cost containment bill. The goal of the bill was to save the state $200 billion in health care costs over the next 15 years. Measures included $135 million in grants to help community hospitals adopt electronic medical records and a 182-day cooling off period for injured patients to negotiate out-of-court with hospitals and physicians.

A few months earlier, some Massachusetts hospitals had also joined a plan which would allow doctors to apologize to patients for medical errors and work to settle malpractice claims out of court. It was based on a model developed by the University of Michigan Health System which was credited with reducing the number of lawsuits.

Our Resources for Patients
Our lawyers have over 100 years combined experience handling medical malpractice and personal injury claims. Please view our patient safety resources.

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medicalerrors.jpgA new Medicare report found that U.S. hospital employees are failing to report the majority of medical errors they make or observe.

The report found only one out of seven medical errors and adverse events are being reported. In these cases, hospitals investigated, but often made no change to prevent future medical errors.

The report was issued today by the inspector general of the Department of Health and Human Services. In reviewing 293 cases in which patients had been harmed, the inspector general found 40 cases were reported to hospital managers and 28 were investigated by hospitals. Only five cases prompted change.

The inspector general estimated more than 130,000 Medicare beneficiaries experienced one or more adverse events or medical errors in hospitals in one month.

The review defined adverse events as medication errors, hospital-acquired infections,
excessive bleeding linked to blood thinner, severe bedsores and overuse of painkillers. Other adverse events at hospitals may include surgical errors, birth injuries and failure to respond to a hospital alarm.

The review found that many hospital employees were fearful about reporting medical errors after the Institute of Medicine’s 1999 landmark report, which estimated up to 98,000 people die in U.S. hospitals each year from preventable medical errors.

But here, employees often failed to recognize what constitutes patient harm, did not realize patients were harmed or assumed someone else would report it. In some cases, employees thought the mistake was so common it did not require reporting.

In recent years, hospitals have been required to track medical errors and adverse patient events as part of their Medicare contract. At least 27 states, including Massachusetts, have implemented laws for mandated reporting of healthcare errors.

Following the inspector general’s report, Medicare officials plan to develop a list of “reportable events” for hospitals and employees. Hospitals are also being asked to give employees their own instructions.

Click for a New York TImes article about this review.

Click for a review of state reporting laws from the National Conference of State Legislatures.
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Each year, more than 150,000 people lose their lives following surgery, even more than the number who die in motor vehicle accidents, according to The Checklist Manifesto by Dr. Atul Gawande. It is a hard number because the majority of surgical errors are preventable.

Gawande, a physician at Brigham & Women’s Hospital, worked with the World Health Organization (WHO) to study use of safety checklists at a number of hospitals around the world. Within months, hospitals using the checklists saw major complications and injuries drop by 35 percent and deaths drop by 47 percent, Gawande reported in his 2010 book.

Many hospitals have since implemented use of the WHO surgical checklist or another protocol. On Wednesday, the Association of periOperative Registered Nurses (AORN) will bring the issue back into focus with “National Time Out Day.”

During the Time Out process, the operating team stops before surgery, runs down the surgical safety checklist and confirms the identity of the patient, the procedure and site of the operation, along with other key information.

More than 300 professional organizations have endorsed the use of a Time Out protocol, but AORN is urging more hospitals to adopt the practice and for those who do to encourage greater participation among all members of the staff.

We encourage all hospitals, surgical teams and patients to pay attention to the safety checklist and Time Out process. If you’re a patient, ask if your hospital uses a checklist. If your hospital doesn’t, find another one. The checklist is critical to saving lives.

Learn About Surgical Safety Checklists
The best way to understand the Time Out process is to see it in action. Click to watch the following video.

Click here to look at the WHO Surgical Safety Checklist.

Click here to look at the AORN Comprehensive Surgical Checklist. This checklist is slightly longer because it brings the WHO checklist together with standards called for by the Joint Commission’s Universal Protocol.
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We commend The Boston Globe for highlighting one of the state’s most pressing problems in health care: too many Massachusetts hospitals and physicians are still using paper medical records.

In a May 7th editorial, the Globe rightly pointed out that electronic medical records, “will prevent errors, improve diagnostic work, avoid duplication of tests and procedures, and simplify clinical studies.” The newspaper called on the 63 Massachusetts hospitals not using any computerized systems to make the change now.

“Electronic medical records would be the best medicine for taking care of medical errors,” Massachusetts medical malpractice lawyer Marc Breakstone said in response to the editorial.

A 2008 study by the Massachusetts Technology Collaborative and the New England Healthcare Institute found just 10 of the state’s 73 hospitals used a computerized system for doctors’ orders. More alarming was the study found 1 in every 10 patients at six community hospitals in the state suffered from serious medication mistakes.

According to the Institute of Medicine, 50,000 to 100,000 patients nationwide die annually of preventable medical errors.

In addition to offering stimulus-bill help, the federal government is threatening to reduce Medicare payments for doctors who fail to implement electronic medical records by 2015. A 2009 national survey by the New England Journal of Medicine showed that only 1.5 percent of hospitals and 4 percent of doctors’ practices have adopted comprehensive electronic systems.

At Breakstone, White & Gluck, we know firsthand electronic medical records will save lives. Massachusetts hospitals are doing the public they should be serving a great injustice every day they continue to make excuses for not going electronic.

For more information, read The Boston Globe’s editorial.
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