One (of many) Culture Gaps in U.S. Health Care Delivery
Service: Hospital Care and Fall Prevention
Policy Makers: Congress and the Center for Medicare and Medicaid Services
Service Delivery: Doctors
In 2005, the Institute of Medicine published a troubling report on the prevalence of life threatening conditions acquired by patients in U.S. hospitals. In response, Congress authorized the Center for Medicare and Medicaid Services to change their repayment policy to prevent such conditions. One amendment to the policy states that hospitals are no longer reimbursed for treating trauma caused by falls that occur in the hospital itself. The amended policy incorrectly implies that hospital falls occur as the result of failures in the health care system, and it has produced unintended, negative consequences.
Medicare and Medicaid reimbursements underpin hospital budgets. To ensure that hospitals continue to receive full reimbursements, administrators deployed technologists to address the problem of in-patient falls. Today, hospitals are building chairs that are impossible to get out of, enclosed beds, and a vast array of bed alarms (even sock alarms). The use of physical restraints has increased dramatically.
Meanwhile, doctors are bemoaning both the CMS policy and the hospitals’ new technology. The unintended consequences of physical restraints (e.g. immobility, functional loss, delirium, agitation, pressure sores, asphyxiation, and death) ultimately cause more harm than the falls that the policy and technology are designed to prevent. In the case of hospital care and fall prevention, there is an obvious disconnect between policy makers, technologists and service providers.