Study: Hospitals Making A Killing On Hospital Infections

220px-ICU_IV_1I have long been amazed by the rate of hospital injuries from preventable bloodstream infections. While there have been a few lawsuits, hospitals appear to have avoided liability for these preventable illnesses. Now, a study in the American Journal of Medical Quality suggests that the situation may be worse than anticipated. Not only is that not a strong litigation deterrent (my view), but this study says that hospitals are actually making a killing by making patients sick. Researchers found that an ICU patient who develops an avoidable central line-associated bloodstream infection (CLABSI) costs nearly three times more to care for than a similar infection-free patient. Here is the most amazing fact: hospitals earn nearly nine times more for treating infected patients.

It is insurance companies who end up getting hit with the bill as well as patients, of course. This is not to mention those patients who become gravely ill or die from this preventable illness.

Private insurers pay the most for patient stays complicated by CLABSIs — roughly $400,000 per hospital stay. That fact could add pressure to hospitals to act reasonably in avoidance of such illness. Currently, there is a surprisingly high economic incentive not to avoid such illness, even if the doctors are morally bound to do so.

The CLABSI infections occur when thin plastic tubes, or central lines, are placed in ICU patients. Each year roughly 80,000 patients with central lines become infected. Now consider that hospital’s average profit margin for treating an infected patient was $54,906 in comparison to an uninfected patient of just $6,506. You do the math. That is a huge amount of income.

Worse yet, the failure to avoid the contamination kills 28,000 people a year. Simple checklists at hospitals have been shown to sharply decrease such contamination. In torts, we often use the Hand formula to determine negligence: B < PL. B stands for burden; P stands for probability, and L stands for loss. When the B is lower than the PL, negligence is generally present. In this case, the B would seem low while both the P and L are high. Normally, that would result in not just negligence but potential punitive damages.

Tens of thousands of people are dying from this preventable illness but relatively little has been done by the government to force new measures or accountability. This is why litigation is sometimes the most direct way to deterring negligence and giving an incentive to take precautionary measures in environments like hospitals.

Source: Hopkins

30 thoughts on “Study: Hospitals Making A Killing On Hospital Infections”

  1. Patric, I’m glad you came in on this one. I enjoy your knowledge and wit. I agree that it takes money, or primo insurance, to access the best. But, a lot of it is regional. If you live in a large metro area w/ university hospitals you have better access than if you live in Moab, Ut. Although, I would still live in Moab in a hearbeat! I’ll read the CBS piece, thanks.

  2. On a positive note; I and I believe most everyone are looking forward to the “paragraph or less.”

  3. I’ll stop quoting you regarding my limited knowledge if you simply take it back. You’re really clogging up this thread. You express concern for this forum. Stopping the rants would help.

  4. Mike S., comments toward Nick S.,

    WOW! Just plain ol’ WOW! I don’t know what else to say! I can’t even comment on the article…

  5. nick spinelli1 said:

    “I wonder why people come from all over the world come for treatment in U.S. hospitals. These are intelligent people w/ money. Must be GREAT hype.”

    Yes, people do come from all over the world . . . to be treated at the finest facilities money can buy.

    You may be interested to know that many of these foreign folks are availing themselves to facilities & doctors that the majority of the U.S. citizenry can never afford.

    The truth is, the best U.S. health care is as fine as anywhere on the planet.

    But there is a considerable drop-off between the “best” and what is affordable for many.

    And just for the record, thousands upon thousands of Americans fly elsewhere, for outstanding health care in other countries, for a fraction of the cost.

    If you’re interested, take a peek at this: http://www.cbsnews.com/2100-500368_162-2104425.html

  6. Adam, “Juries love doctors most of the time,” is to vague for me to know if I should agree or disagree w/ you. There are many variable. Some of the varaibles are:

    Venue: Some love docs and some don’t. Very generally, rural juries like to love them and urban are skeptical to dislike. There are many exceptions to this, again I’m being general. I could be specific about counties in Wi. and Illinois, but that’s inside baseball.

    Specialty: There’s a reason ob/gyn’s have the highest insurance. However, it’s often not so much that they dislike the doc, but feel so bad for the parents. John Edwards was a superstar in getting awards for parents. Too bad he got his bar license revoked. I’m sure he could use the dough right now.

    Obviously, surgeons are way up there in vulnerability. And, they often lack personal skills. For myself, I don’t care if the guy cutting me is a super jerk, I want an ace w/ a knife. If Charles Manson was an ace surgeon, I would hire him..unless I couldn’t find another equal ace sans swastika on his forehead. This ties in w/ another very important factor. Obviously the best way to not go in front of a jury is to not get sued. And, the personal relationship a patient has w/ his doc, no matter the specialty, is key in whether they will be sued.

    And I again give the disclaimer that the two topics that I’ve been told I know something about are “Sports and movies.”

    Mespo knows much more than me. Hopefully he’ll comment on this thread.

  7. Why does this not surprise me knowing the toxic substances they freely put into vaccinations with a I care about you look, Yea right.

  8. You talk about litigation being a direct way to cause change. But, medical malpractice suits on this issue are not very likely to win. Whenever a patient undergoes any procedure the risk of infection is always there and people sign informed consent forms on that fact. Juries love doctors most of the time and since you may not be able to point to an exact thing that caused the infection, defense verdict.

  9. “…when the truth is that for most who write here, including me, this isn’t a competition.”

    Hear, hear.

  10. Ah, but the question is how preventable are these infections? It’s easy to say, but less easy to demonstrate, that these are preventable.

    Consider these premises:

    a) There are no sterile environments available for conducting medical care.

    b) Bacteria are ubiquitous in the environment.

    c) There are about 10,000 bacteria per square centimeter on your skin.

    d) Rubbing your arm with an alcohol pad is merely for show as almost all of these bacteria are not harmed by alcohol.

    Therefore it is always true and unavoidable that medical care will lead to infections. The doctor will say that the treatment given was chosen because the potential benefit to the patient outweighed the inevitable risk. Unless a _specific_failure_ can be demonstrated, where is the tort?

    Hand wringing is easy. And improving medical care is always desirable. But how do you show that some specific additional process will reduce infections? It’s no good saying that we should do everything possible to avoid them since we could easily double, triple, or quadruple the cost of all procedures with additional anti-infection steps without even succeeding in reducing infections.

  11. I merely quoted what you have said about my limited knowledge.

    1. “I merely quoted what you have said about my limited knowledge.”

      And you ask why I call you dishonest? From Nick 5/22 at 8:43pm:

      “I am not chastened, just hoping to end this. Are you done?”

      Above on 5/23 at 9:12am:

      “Since I’ve been told the only subjects of which I know anything are, “Sports and movies,”

      So after you were called out last night and portraying yourself as “trying to end it” , you again tweak it. That is because you are a deceitful game player, who really thinks you are in a competition here. A competition that exists only due to your own huge ego and your own self justifying mind.

      From 5/23 at 9:44am

      “My saying a personal meeting would help did not imply intimidation. It did mean words like, “prick”, “STFU,” and references to my deceased sister and incest w/ my daughter would be much less likely.”

      Of course it implied intimidation Nick, especially preceded by:

      “But, remember what I did for a living. I can handle lightweights like this. I’ve handled heavyweights. I just wish the 3 of us could sit in a bar together.”

      To me that whole comment of yours implied a person who has spent his life as a bully and you’ve admitted you’re a large person. Why would you use sit in a bar together, rather than just “sit down together”? Because in bars there is always the implication of physical intimidation and that is your essence Nick and why I react to you. I don’t like bullies, especially those that do so in a cowardly, surreptitious manner, as you do.

      Here is part of the problem you have with me and Gene. Your first comment on this blog was one full of the type of braggadocio that implies “I can lick anyone in the house”. When I responded to that and proved that you simply didn’t possess the written skills, nor the logical tools, to cause problems for most who regularly comment here. In your skewed perception you saw me as
      someone here to take down, thus raising yourself up. When Gene noticed the same lack of forensic tendencies in you he chimed in. Now you had two perceived “enemies”, made even more chafing to you because we are guest bloggers. In your macho, ego driven mind you were capable of taking us down
      in debate, but sadly you overestimate your skill set. Since you lack the logical skills to actually take us on in debate you follow us around making snide comments. Pathetic. Now as far as Gene attacking your family that too is a result of your own doing. You said that nobody could take you on in “dozens”, being too dumb to know what “dozens” is about. As Richard Pryor put it “dozens” is a Black game that usually begins with and follows through with:
      “Yo Mama is such and such”. Gene merely accepted your challenge and like the egotistic bully you are you folded. That must really gall you Nick.

      As Tony C. cogently summed you up:

      “Nick: I can handle lightweights like this. I’ve handled heavyweights. I just wish the 3 of us could sit in a bar together.

      In the spirit of education, when you make apparent veiled reference to your fighting prowess and then express a veiled desire for a physical confrontation, that implies a threat to people.

      I’m not sure why you think being in somebody’s face would change their mind, unless you are just accustomed to using intimidation, raising your voice or using body language threats to quell debate and then thinking you have “won.” (When what you have really done is just prevented somebody from voicing their opinion in your presence.)

      Like the six gun, the Internet is the great equalizer, Nick. Your arguments stand or fall on their language alone. Aggressive guys and crazy people don’t get to intimidate people into letting them have the last word, the cute girls don’t get a pass with a smile, the disabled or emotionally fragile don’t get a condescending sympathy pass.

      That can be a shock to those that have subconsciously relied on their physical traits in interpersonal exchange, to suddenly be treated much differently online than they get treated in person.

      But it should be taken as a self-awareness lesson; and in a way it is freeing to learn how to interact without reliance on such interpersonal traits (or being subjected to them). Your physical presence, whatever it conveys, is not an argument, it is at best an expression of your emotional state or an expression of intimidation or supplication, none of which should influence the argument at hand.”

      And then Tony goes on after you deliberately backtracked on your meaning:

      “Nick: My saying a personal meeting would help did not imply intimidation.”

      “As a said, as a matter of education: You may not think so, but they do. What others infer from your words is not up to you, and as ONE of the others I was pointing out to you what others may infer, which is a desire for physical confrontation whether you intended it or not.

      As for the rest, you immediately contradict yourself when you claim, “I’m big, but that was a non factor for the most part. It merely stopped people trying intimidation w/ me.”

      What you are saying there is that your physical size changes the dynamic of the conversation with other people. Obviously, if your size prevents other people that usually use intimidation from trying to intimidate you, then you are large enough to intimidate many people smaller than you. By your own admission, you essentially frighten them into civility in their word choices and comments; you think that to your face they can’t tell you to STFU or in response to your provocation imply you have had sexual relations with your sister. Why do you think that? What threatening consequence does your physical presence convey that would prevent such language?

      A hatred of telephone interviews or keyboard debate implies one thing: You rely so heavily on personal presence that you are incompetent without it. You can resent that and abandon the field, or you can recognize it and teach yourself to walk without the crutches.”

      I’ve more than proven who you really are in two long posts and frankly that wastes my time. Until you learn to stop playing your usual intimidation and then victim game I will keep calling you out, but will do so in a paragraph or less. While there are many here who are far better equipped for logical debate than I, you are not among that group. In truth you are low down on the totem pole of those who comment here, but you just don’t know it.

  12. My mother died from a hospital-acquired blood infection. The lawyers said that there was no possible tort. The hospital had followed generally accepted procedures.

  13. I can assure you it’s worse than you can imagine. I was given the wrong meds and ended up in ICU. The nightmare of that scenario was such that most people would not believe me. The nightmare following it was equal to that. You cannot sue I was told by law firm after law firm because they have incorporated. It is not advantageous for law firms to try and sue unless you have lost either life or limb. Pain and suffering are not worth mentioning these days.

  14. The past Director of CDC, Julie Gerberding essentially dismantled the program for preventing hospital infections, by shifting to a treatment orientation.

  15. I wonder why people come from all over the world come for treatment in U.S. hospitals. These are intelligent people w/ money. Must be GREAT hype.

  16. Since I’ve been told the only subjects of which I know anything are, “Sports and movies,” may I suggest a good flick that manmy have not see, The Hospital. It stars the great George C. Scott.

    I do know a little about hospitals and med malpractice, working w/ good to great attorneys for over 30 years. The states were Illinois and Wisconsin. The hospitals were major urban like Northwestern, Michael Reese, Loyola, etc. to mid sized city hospitals in Madison and rural hospitals in southern Wi. Stay away from small, rural hospitals for too many reasons to explain. If for some reason you end up in one for emergency reasons, transfer as soon as possible even if you have to pay for it yourself. However, while large hospitals are better to much better, they are still dangerous to your health. Always INSIST that ANYONE who comes into your room wash their hands. Good hospitals train the staff to always announce who they are and what they are doing in your room. If they don’t, ask them. And keep a journal. There is much more, but I’ll leave it there. It’s not “sports or movies,” so I don’t want to step out of my assigned expertise.

    1. “Since I’ve been told the only subjects of which I know anything are, “Sports and movies,” may I suggest a good flick that manmy have not see,”

      Nick,

      You just don’t get it do you. Little games like this are what gets you attacked time and again, yet you plead that you’re a victim. You keep saying let’s end this, but like in much else you lie.

      Your advice about hospitals was good, but rather than leave it at that you went further. This is the innate dishonesty that you represent. You really think you are competing for something, when the truth is that for most who write here,
      including me, this isn’t a competition.

  17. As someone who spent perhaps 6 months of and in the hospital in 2010 I can attest to the problems that arise from the use of intravenous lines. Thankfully, I never received and infection, yet the possibility was there as the staff seemed to at time forget that there was an intravenous (at time two) needle in my forearms. Typically these needles should be dated and dealt with every other day, yet often I would have to remind staff to tend with them. Then two normal arm movements, sometimes during sleep, would affect the positioning and cause bleeding, thus the possibility of infection.

    At one point I had a line inserted into my carotid artery by an intern who had never done it before. It caused clotting that lodged in my lungs. Due to the clotting one month after my heart transplant I was rushed to the hospital with severe respiratory problems and needed a lung operation to remove the clots.

    My experience with hospitals is that despite the caring of the staff the treatment of many people multiplies the possibilities of error. A patient and his family must be ever vigilant and proactive as to the parameters of their treatment. The hospitals though, must also give greater effort towards actual patient safety, rather than a reliance on “pristine” procedures. The reality is that our hospital care is overpriced and less effective than in other countries despite the hype.

  18. Welcome to the new age:

    The article points out that deaths due to “iatrogenic causes” during hospital care results in 225,000 deaths per year in the United States.

    The outpatient care which follows that hospitalization results in an additional 199,000 deaths due to those “iatrogenic causes”.

    The not so grand total is 424,000 deaths per year that were due to negligence, accidents, or incompetence.

    An “iatrogenic cause” is defined as:

    i·at·ro·gen·ic: Induced in a patient by a physician’s activity, manner, or therapy. Used especially of an infection or other complication of treatment.

    (Dictionary). What this boils down to is that, in the health care system discussed, the treatment is sometimes worse than the disease.

    (Terrorism We Can Believe In?). The figures come from Journal of the American Medical Association (JAMA) Volume 284, No. 4, July 16, 2000.

    I doubt things have changed much based upon JT’s post.

  19. My friend’s father died from a preventible infection. His doctor was so upset about it that’s what he put on the death certificate. They sued. Hospitals need to find that such carelessness costs more than the resulting charges for care.

  20. Have to make up the cost somewhere…. Dr. Mengele I’m sure would be proud…..

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