Medicare No Longer Willing to Pay Hospitals for Preventable Medical Errors

Under new rules to be published next week, Medicare will soon cease paying for the extra costs of treating preventable errors, injuries and infections that occur in hospitals.

Private insurers are considering similar changes.

Among the conditions that will be affected are bedsores, or pressure ulcers; injuries caused by falls; and infections resulting from the prolonged use of catheters in blood vessels or the bladder.

In addition, Medicare says it will not pay for the treatment of “serious preventable events” like leaving a sponge or other object in a patient during surgery and providing a patient with incompatible blood or blood products.

New York Times - August 18, 2007 (free registration required).

These new rules, which go into effect October 1, 2008, will have considerable impact.  Proponents say it’s about time; opponents question whether additional, expensive testing will be done on patients at hospital admission to document any conditions they may have upon arrival, and whether all of the listed hospital acquired conditions are indeed preventable.  Will this improve healthcare, or will it further distress already over-burdened hospitals and providers?

Related Links:

Statement of Support for CMS-1533-P from Consumers Union

DHHS Notice Regarding Prospective Payment Systems for Inpatient Hospital Services
See Pages 152 - 194  Section F. Hospital-Acquired Conditions, Including Infection

CMS Hospital Center

CMS-1533-P Published in the May 3, 2007 Federal Register
Technical Corrections Published in the June 7, 2007 Federal Register

Medicare Won't Pay for Hospital Mistakes - Yahoo News

8/21/07 - New York Times Op Ed: Not Paying for Medical Errors

Update 5/08 - http://msspnexus.blogs.com/mspblog/2008/05/hospital-acquired-condition-reduces-reimbursement.html

Comments

[Doctor Anonymous]

Thanks for pointing out this article. I had so much to say, I wrote an entire post on it.

[Rita Schwab]

I agree Dr. A. - this is one to watch!

[rxmom]

While a agree with the basic premise, and can visualize the nudge towards improving the quality of care that will result from the extra care taken by providers to minimize the potential loss of revenue by the health care systems, there must be an appellant route provided on a case by case basis. We do expect our providers to make their best judgment where it pertains to treatment, so we cannot let the dark cloud of monetary loss to influence such decisions.

[Steve P.]

Dr. Sanjaya Kumar's new book, Fatal Care: Survive in the U.S. Health System, will certainly open your eyes about preventable medical errors. These true stories really hit home and offer valuable lessons on how to protect yourself and your loved ones.