Have You Found That Missing Sponge, Bob?

Accountable Care OrganizationsOne of the interesting things to come out of Health Care Reform is the push from insurance companies to get hospitals focused on quality.  As an example, some research indicates that a medical sponge is left inside a patient one tenth of one percent of the time.  That’s 1 in 1000.  Doesn’t seem like much of a problem right?  Well, maybe you’ll reconsider once you read this story in the Miami Herald.  Two words I never want to read again: festering sponge.  The point of the story for insurance companies is that while one surgery is expensive, two surgeries is MUCH more expensive.  In fact, Medicare and most private insurers will not pay the hospital at all for the surgery to remove the sponge.  This is just one example of making providers accountable.

The new health reform law talks a lot about Accountable Care Organizations, which you can find out more about at the Code Red blog.  The idea is to provide the hospitals and doctors with one lump sum up front to treat a patient’s condition.  If the cost of treating that patient is more than they received, they have to eat the difference.  But, if the hospital team is able to treat the patient for less, not only do they keep the difference but they may also get a bonus from the insurance company.  Blue Cross has recently entered into an accountability contract such as this with the Advocate Hospital System.  Hopefully, this will lead to better care for the patients and a way to rein in health care costs and in turn, insurance premiums.

So, what are hospitals to do about missing sponges?  While most hospitals count sponges going in and then coming out, there are new technologies available now.  The Mayo Clinic says that before they implemented a computer scanning system (like the kind used at Target or the grocery store), they were losing a sponge a month (!) inside of patients.  For the past year and a half, using the system, they haven’t lost one.  Think about that for a minute.  That means that there have been 12 fewer unnecessary operations over the course of a year, which probably equates to hundreds of thousands of dollars saved not to mention the malpractice awards.  You probably will be hearing a lot more about Accountable Care Organizations in the very near future.  In the meantime, why don’t you let us take a look at your current group health policy?


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