In Reducing surgical complications: How to make it happen faster, I contrasted the way a hospital gets paid for rework with what happens in a manufacturing environment. In short: when a manufacturing process messes up a product the company doesn’t get paid at all, but when a hospital messes up it tends to get paid for the original flawed product and then paid again to fix it.

I heard about an experience yesterday that makes the same point. A friend had a routine blood test in the morning at a hospital clinic. When results came back at the end of the work day there was an exceedingly high reading on the sodium level. The doctor who ordered the test called the patient to say he needed to go in to the emergency room to have it checked out, since the reading was higher than the doctor had ever seen for a patient and such a level could be life-threatening.

The patient went in, had a repeat test –which came back completely normal– and departed after paying the $150 co-pay. The attending physician in the emergency department referred to it as an iatrogenic event. No doubt the hospital will get paid in the low four figures for the visit, which wouldn’t have happened if the lab had done its job well the first time.