Margret Spinner-Ramirez is a 66yr is a Hispanic-American
Landmark studies To Err is Human (1999) and Crossing the Quality Chasm (2001) from the Institute of Medicine (IOM) identified medical errors are causing harm and death to almost 45,000 Americans and costing over $29 billion every year. Other studies, have indicated preventable healthcare associated conditions (HACs) such as infections, sepsis, and pneumonia are main contributors for increasing the length of patient stays, the cost of care, and the likelihood of mortality (death).
Consider the below case study:
Margret Spinner-Ramirez is a 66yr is a Hispanic-American. She speaks both Spanish and English fluently. She was scratched by a stray cat that she feeds on her back porch daily. She went into her local ER two days after the incident for pain, and swelling in her left lower leg where she was scratched by the stray cat. Ms. Spinner-Ramirez also complained of difficulty with baring weight on that extremity. Vital signs stable, and Ms. Spinner-Ramirez was sent home on oral Keflex for her skin infection. Five days later Ms. Spinner-Ramirez was taken back to the same ER via ambulance. She was lethargic and had difficulty being able to move. Cat scan and blood work revealed that Ms. Spinner-Ramirez’s knee replacement in her left leg was infected secondary to the cat scratch. Ms. Spinner-Ramirez was admitted for sepsis. She needed to have her old knee replacement removed, six weeks of IV antibiotics, new knee replacement placed, and rehab.
If you were in charge of a healthcare insurance company:
- Explain why insurance companies (which are considered payers) should or should not pay (reimburse) for injuries, extended costs, readmissions, or death (mortality) from a hospital-acquired infection or medical error. Support your why or why not?
- Describe two ways (initiatives) healthcare quality can be improved to help reduce errors and improve patient safety.
- Discuss how creating incentives for providers (healthcare organizations) can improve quality and reimbursements (payments) for services/care.