The Center for Medicare and Medicaid Services today proposed cutting off payments for inappropriate surgery. No, it's not the unnecessary back and cardiac catheterization surgeries they're going after. It's when hospitals operate on the wrong patients, or operate on the wrong body part, or conduct the wrong surgery on the right patient. You can file comments by clicking on the links.

The American Hospital Association response to the proposed decisions was interesting. In their initial comments to CMS, they said the guidelines should specify that:

1) the error or event must be preventable; 2) the error or event must be within the control of the hospital; 3) the error or event must be the result of a mistake made in the hospital; 4) the error or event must result in significant harm; and 5) the error or event must be clearly and precisely defined in advance.

The last two caught my eye. Number four, for instance, seems to suggest that if they put in an artificial hip on the wrong side, but it works well enough, then they should still get paid. And I can't figure out what number five means.

Anyway, it's an interesting concept, not paying hospitals for preventable mistakes. The Institute of Medicine a few years ago estimated medical errors accounted for up to nearly 100,000 patient deaths a year, making it one of the nation's leading causes of death. Under the existing fee-for-service system, medical error represents just another opportunity to offer more health care. Hopefully, these new rules will remove one source of those perverse incentives.