Five hospital secrets you should know
Oct 1st 2009 6:00AM
Updated Dec 4th 2009 4:12PM
Going to the hospital for any reason is bad enough. But it can be particularly grueling if you receive substandard care, get stuck with a bill full of mistakes or wind up sicker than when you were first admitted.
While most patients check in and out without incident, there are plenty who haven't been as lucky. On average, one person at every hospital is harmed by a drug error -- every day, according to a 2006 study by the Institute of Medicine. It gets worse. The Centers for Disease Control estimates that roughly two million people a year get hospital-related infections, many of which are potentially lethal. About 195,000 patients die each year from hospital errors, according to healthcare ratings firm HealthGrades.
There are some little-known ways to protect yourself, however. Here are five hospital secrets you need to know.
Be extra careful in July. Why?
Newly-minted interns start work that month.
A study of 200 major teaching hospitals in the United States found that during July, a large number of experienced employees leave, and less experienced ones arrive. That migration is "associated with roughly 1,500 to 2,750 accelerated deaths per year," according to the National Bureau of Economic Research.
It makes sense that inexperience coupled with the adjustment to unfamiliar surroundings and long hours might be a source of increased errors affecting patient care. However, this potential connection between new staff and poor outcomes is not without its detractors. Another study by researchers at the Iowa City VA Hospital in Iowa City, Iowa found no evidence that patients in the intensive care units of 28 hospitals fared any worse due to "the July phenomenon."
While the experts may not be able to agree, why tempt the fates? Just postpone any surgeries until August or, even better, September.
Secret No. 2: Checking a hospital's rating can save your life
What causes more deaths than diabetes, pneumonia, Alzheimer's disease or kidney disease? Preventable, in-hospital medical errors.
HealthGrades estimates that these types of screw-ups kill an estimated 195,000 people each year. That's the equivalent of 394 fully-loaded jumbo jets crashing and killing everyone on board.
The majority of medical-error deaths stem from an improper diagnosis or failure to treat a problem in a timely manner. Less common, but just as serious, are errors that include avoidable post-operative respiratory failure and pulmonary embolisms.
How can you protect yourself? Consider obtaining a ratings report for your hospital from the U.S. Department of Health & Human Services or from private providers such as HealthGrades or The Leapfrog Group. Another resource is the annual ranking of America's Best Hospitals by U.S. News & World Report.
We are discussing your life here. Doing a little due diligence can go a long way toward saving it.
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Secret No. 3: During the most critical part of your surgery, you may be receiving less competent care
Before setting foot in the operating room, you most likely will conduct a background check on your surgeon. But what about your anesthesiologist?
While serious complications from anesthesia are rare, they can occur, and the consequences can be deadly. Patients who require general anesthesia and who have pre-existing medical conditions are at an even greater risk.
According to Dr. Bruce Fagel, a medical malpractice lawyer who is also a physician, most surgical patients know little or nothing about their anesthesiologists. Even worse, most hospitals outsource their anesthesiology services to a group that may just randomly assign an anesthesiologist to a patient, he says.
All patients undergoing surgery should insist on interviewing anesthesiologists prior to surgery. Here are some questions the American Society of Anesthesiologists suggests you ask:
• What are your qualifications? Specifically, are you a medical doctor trained in the field of anesthesiology?
• How many procedures like this have you done?
• Who else might be involved with my anesthesia care?
• Do you monitor my heart and breathing?
• Is an anesthesiologist on call to respond to the recovery room?
Secret No. 4: You don't have to pay for the hospital's mistakes
Minor infections, like urinary tract infections from catheters, happen all of the time in hospitals. Often, however, these infections are preventable. If that's the case, then you don't have to pay for cost of treating them.
Medicare has drawn a line in the sand. Starting in October 2008, it stopped paying for designated hospital errors. State medical groups, insurers and state agencies have jumped on the bandwagon, too. Now hundreds of hospitals have agreed to absorb the cost of their mistakes.
If you are the victim of a hospital error and are asked to pay for treating the ensuing problems, just say "no." There is a good chance the hospital has no right to bill you. Even if it is not prohibited from doing so, it is unlikely to pursue you for payment.
Secret No. 5: Your medical records are not as confidential as you think
If you think that gall bladder surgery is something that's going to stay between you, your doctor and the nurses, think again. The information you share at the hospital doesn't always stay in the hospital.
Celebrities have learned this the hard way. Hospital records of Britney Spears, Maria Shriver and Farrah Fawcett were reportedly provided to the tabloids by hospital employees. Believe it or not, you and I face similar risks. When put in the wrong hands, medical records can prove to be highly valuable. Earlier this year, an employee of the prestigious Cedars-Sinai MedicalCenter in Los Angeles was arrested and charged with stealing more than one thousand patient records, and then using the patients' identities to steal from insurers.
Even if your information doesn't get used to make a quick buck, it still gets around. Patients believe that HIPAA, the federal law governing the privacy of medical records, protects them from disclosure. But HIPAA has many exceptions. Here are a few of them:
• Disclosure to affiliated organizations. This can include many providers in different states. That may be fine unless your nosy Uncle Fred works in one of those entities.
• Limited disclosure for hospital fundraising (the hospital may use your name and demographic information to solicit donations). You can opt out, but few patients understand their right to do so.
• Disclosure for national security. This may not sound like a problem, but no court review or order is necessary prior to disclosure. The potential for abuse is huge.
If you are concerned about the privacy of your hospital records, you are entitled to request an accounting of all disclosures. Review the hospital's Notice of Privacy and follow the procedures.
Dan Solin is the author of the newly published book, The Smartest Retirement Book You'll Ever Read (Perigee Books 2009). His prior books include the New York Times bestsellers, The Smartest Investment Book You'll Ever Read and The Smartest 401(k) Book You'll Ever Read. See SmartestInvestmentBook.com. Read more about Dan Solin.