Victims of botched up surgeries generally suffer in silence, cough up more money to get things right. Some do move the courts, with mixed results.
And here comes the news that a hospital group in central Pennsylvania is offering warranty on its workmanship, charging a flat fee that includes 90 days of follow-up treatment.
Even if a patient suffers complications or has to come back to the hospital, it would not to send the insurer another bill.
Well the Geisinger Health System that has been implementing the idea on an experimental basis for a year now says it is not wooing customers as manufacturers of TV sets or washing machines.
Since Geisinger began its experiment in February 2006, focusing on elective heart bypass surgery, it says patients have been less likely to return to intensive care, have spent fewer days in the hospital and are more likely to return directly to their own homes instead of a nursing home.
Geisinger presented the first-year results of its experimental program at a meeting last month of the American Surgical Association.
Reviewing the existing professional guidelines and medical literature, Geisinger's cardiac surgeons came up with their list of 40 action items viewed as best practices — like screening a patient for the risk of a stroke before surgery or administering beta blocker drugs after surgery to reduce the chances of an irregular heartbeat.
Then they devised procedures to ensure the steps would always be followed, regardless of which surgeon or which one of its three hospitals was involved.
Geisinger's 40-step system makes sure every patient gets the recommended treatment.
It is still too early to know whether the approach, which Geisinger calls Proven Care, will catch on with employers and health insurers.
So far, the only insurer that Geisinger has contracted with under the new arrangement is its own insurance unit, which covers about 210,000 people in Pennsylvania. Eventually, though, Geisinger hopes to attract other insurers and employers that provide health benefits by expanding the approach into other lines of care provided by the nearly 660 doctors it employs at its three hospitals and 55 offices in the region.
Geisinger is trying to address what it views as a fundamental flaw in the typical medical reimbursement system.
Under the typical system, missing an antibiotic or giving poor instructions when a patient is released from the hospital results in a perverse reward: the chance to bill the patient again if more treatment is necessary. As a result, doctors and hospitals have little incentive to ensure they consistently provide the treatments that medical research has shown to produce the best results.
Researchers estimate that roughly half of American patients never get the most basic recommended treatments — like an aspirin after a heart attack, for example, or antibiotics before hip surgery.
The wide variation in treatments can translate to big differences in death rates and surgical complications. In Pennsylvania alone, the mortality rate during a hospital stay for heart surgery varies from zero in the best-performing hospitals to nearly 10 percent at the worst performer, according to the Pennsylvania Health Care Cost Containment Council, a state agency.
Around the world, other modern industries — whether car manufacturing or computer chip making — have long understood the importance of improving each piece of the production process to tamp down costs and improve overall quality.
But hospitals have been slow to focus their attention on standardizing the way they deliver care, said Dr. Arnold Milstein, the medical director for the Pacific Business Group on Health, a California organization of large companies that provide medical benefits to their workers. Geisinger "is one of the few systems in the country that is just beginning to understand the lessons of global manufacturing," Dr. Milstein said.
The doctors nevertheless needed some persuading that Proven Care would not be some form of inferior cookbook medicine, said Dr. Charles H. Benoit, a cardiac surgeon. "It's not that we were a uniquely compliant group of personalities," he said.
The challenge now is to develop the same exacting standards for other kinds of care, like hip replacements, where there is much less medical agreement about what constitutes best practice, Dr. Glenn D. Steele Jr., Geisinger's chief executive, said.