Hmmm…needlestick…let’s get the patient to pay for some of the cost

By: November 10th, 2010 Email This Post Print This Post

Sometimes I am forced to assume my angry safety officer persona.

A reader wanted to know, in the event of an accidental needlestick, if it was okay to charge the cost of the source patient’s blood tests to insurance.

This is one thought process that shows what is wrong with healthcare in the United States.

You see, OSHA makes it crystal clear that testing and postexposure follow up costs for needlesticks must be at no cost to the employee. See for yourself by reading sections(f)(1)(ii)(A) and (f)(1)(iii) of the Bloodborne Pathogens standard.

The standard isn’t specific about cost for the source patient testing—OSHA doesn’t regulate the relationship between healthcare facilities and patents, but it does between healthcare employers and employees. But you’ve got to believe that it is wrong, and certainly not the intent of the standard, to charge a patient for something for which he or she was not responsible (the needlestick) or for something the patient’s current health status doesn’t require, namely HBV, HCV, and HIV blood work.

Indeed, I would argue that charging the source patient for anything related to the needlestick response could make the source patient more likely to refuse or delay consent, which would violate the standard’s requirement to obtain consent and run source patient tests “as soon as feasible,” as stated in section (f)(3)(ii)(A).

I know healthcare is a business, but charging the source patient for a needlestick cost is, in my opinion, unconscionable.

If that ethical argument doesn’t sway you, let me make a business case for it, albeit cynically.

They are unfortunate, and every effort should be made to eliminate them, but the expenses related to needlesticks are a cost of doing business in the healthcare sector. It’s a write-off.

And so, sadly, are OSHA fines.

Does your facility charge needlestick-related cost to patients’ insurance? I hope not to see any affirmative answers in the comment section below.

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Our hospital does not charge patient’s or their insurance for the mistakes of the employee or phys. We have a special order code that prevents that from happening.

I totally and fully agree with David’s article. Patients did not come to your facility to have their blood tested for HIV, Hep B and Hep C. Actions of the employee are the typical cause of blood exposures. We would not think of charging the patient.

I also take exception to the notion that their insurance should pay for this.

I agree- I have worked for 3 facilities that represent over 20 hospitals in our state. The policies (standard for the whole system in each instance) where to code the tests so charges for the source patient were part of the employee health budget. The patient should never be resposnible to pay for the testing. It needs to be in the overall facility budget for providing care. Most of the time, the results are negative. In the rare occasion when an unknown positive is found, it does help the patient get treatment in a more timely manner. But that is the exception not the rule of what is seen.


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