Health News

Blog Chatter

What are tags?

List

ontheflie on Wall Street Titan Goldman Sachs Gives Back Some Money to Main Street
lmfl0 on Transbordador Atlantis aterriza con éxito
bigarreola on Edgar Sosa, seis meses fuera de acción
tronco1512 on Activistas por reforma migratoria diversifican frentes
UN CAPITULO MAS on Lula exige a 'gringos' pagar por preservación de Amazonia

Currently experiencing technical difficulties. Please refresh page or try again later.

Medicare Won't Pay for Hospital Errors

By ROBERT PEAR,

The New York Times

Posted: 2007-08-20 06:33:39

Filed Under: Money, Health News

WASHINGTON (Aug. 18) — In a significant policy change, Bush administration officials say that Medicare will no longer pay the extra costs of treating preventable errors, injuries and infections that occur in hospitals, a move they say could save lives and millions of dollars.

Private insurers are considering similar changes, which they said could multiply the savings and benefits for patients.

Under the new rules, to be published next week, Medicare will not pay hospitals for the costs of treating certain “conditions that could reasonably have been prevented.”

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.

Feed

More Stories

“If a patient goes into the hospital with pneumonia, we don’t want them to leave with a broken arm,” said Herb B. Kuhn, acting deputy administrator of the Centers for Medicare and Medicaid Services.

The new policy — one of several federal initiatives to improve care purchased by Medicare, at a cost of more than $400 billion a year — is sending ripples through the health industry.

It also raises the possibility of changes in medical practice as doctors hew more closely to clinical guidelines and hospitals perform more tests to assess the condition of patients at the time of admission.

Hospital executives worry that they will have to absorb the costs of these extra tests because Medicare generally pays a flat amount for each case.

The Centers for Disease Control and Prevention estimates that patients develop 1.7 million infections in hospitals each year, and it says those infections cause or contribute to the death of 99,000 people a year — about 270 a day.

Intravenous catheters are widely used to provide hospital patients with medications, nutrition and fluids, but complications are relatively common.

One state, Michigan, has had spectacular success with systematic efforts to reduce infection rates in intensive care units.

Susan M. Pisano, a spokeswoman for America’s Health Insurance Plans, a trade group, said, “Private insurers will take a close look at what Medicare is doing, with an eye to adopting similar policies.”

Consumer groups welcomed the change. And while hospital executives endorsed the goal of patient safety, they said the policy would require them to collect large amounts of data they did not now have.

Lisa A. McGiffert, a health policy analyst at Consumers Union, hailed the rules.

“Hundreds of thousands of people suffer needlessly from preventable hospital infections and medical errors every year,” Ms. McGiffert said. “Medicare is using its clout to improve care and keep patients safe. It’s forcing hospitals to face this problem in a way they never have before.”

Christine K. Cahill, a registered nurse who used to inspect hospitals for the California Department of Public Health, said: “This is a great start. Infection-control specialists have been screaming for 20 years that federal and state officials should pay more attention to this problem because hospital infections hurt patients and cost money.”

The Bush administration estimates the new policy will save Medicare $20 million a year. But other experts say the savings could be substantially greater.

Nancy E. Foster, a vice president of the American Hospital Association, agreed that doctors and hospitals knew how to prevent the transfusion of incompatible blood products and should not be paid more if they accidentally left objects in patients during surgery.

But Ms. Foster said that some of the conditions cited by Medicare officials were not entirely preventable. Commenting on the proposed rules in June, the American Hospital Association said, “Certain patients, including those at the end of life, may be exceptionally prone to developing pressure ulcers, despite receiving appropriate care.”

In most states, Ms. Foster said, hospital records do not show whether a particular condition developed before or after a patient entered the hospital. Under the new rules, she said, hospitals will have to perform more laboratory tests to determine, for example, if patients have urinary tract infections at the time of admission.

Dr. Tammy S. Lundstrom, the chief medical officer at Providence Hospital in Southfield, Mich., said, “The rules could encourage unnecessary testing by hospitals eager to show that infections were already present at the time of admission and did not develop in the hospital.” Moreover, she said, “Serious, costly infections can occur even when doctors and nurses take all the recommended precautions.”

The rules, first reported in The Star-Ledger of Newark, carry out a directive from Congress included in a 2006 law. When they were proposed in May, consumer advocates said they feared that some hospitals might charge patients for costs that Medicare refused to pay.

But that is forbidden. “The hospital cannot bill the beneficiary for any charges associated with the hospital-acquired complication,” the final rules say.

Eileen O’Neill-Pardo of Everett, Wash., said her experience showed the need for the rules. Her 82-year-old mother, Margaret M. O’Neill, died of an infection that developed during intestinal surgery at a Seattle hospital in 2004.

“The operation — to remove scar tissue — was successful, but the patient died,” Ms. O’Neill-Pardo said. “The hospital staff did not take steps to control the infection, which took over her body. My mother died less than a week after the operation.”

Michigan hospitals have been extremely successful in reducing bloodstream infections related to such catheters, researchers reported recently in The New England Journal of Medicine. The hospitals did not use expensive new technology, but systematically followed well-established infection-control practices, like covering doctors and patients from head to toe with sterile gowns and sheets while the catheters were inserted.

Hospital executives said these techniques had saved 1,700 lives and $246 million by reducing infection rates in intensive care units since 2004.

Some of the complications for which Medicare will not pay, under the new policy, are caused by common strains of staphylococcus bacteria. Other life-threatening staphylococcal infections may be added to the list in the future, Medicare officials said.

Dr. Kenneth W. Kizer, an expert on patient safety who was the top health official at the Department of Veterans Affairs from 1994 to 1999, said: “I applaud the intent of the new Medicare rules, but I worry that hospitals will figure out ways to get around them. The new policy should be part of a larger initiative to require the reporting of health care events that everyone agrees should never happen. Any such effort must include a mechanism to make sure hospitals comply.”

2007-08-19 07:42:13

Must Read?

92 %

8 %

0 VOTES

Recent Comments

Post Your Own

1 - 10 of 2541

2541 comments

Mvp1931xl 08:00:00 PM Dec 13 2007

Report This!

Hospital are not the only one to couse injurys. Office surgery injury are very camen, and the surgen can easly change the records. I am one of them.

Mvp1931xl 07:59:00 PM Dec 13 2007

Report This!

Hospital are not the only one to couse injurys. Office surgery injury are very camen, and the surgen can easly change the records. I am one of them.

jonesbarbi 02:04:22 PM Sep 10 2007

Report This!

JUST MAYBE THE DOCTORS, NURSES AND SOCAL WORKERS AND EVERYONE IN HEATH CARE WILL TAKE ALOT BETTER CARE OF PEOPLE NOT JUST SOME ALL PEOPLE ARE HUMANS, IF YOU NEGLECT A CAT, DOG, HORSE, YOU GO TO JAIL. BUT NURSES, DOCTORS, AND OTHER THAT WORK IN HEALTH CARE. GET AWAY WITH MURDER EVERY DAY. BJC HOSPITAL AND THIER PARTENERS WASHINGTON UNIVESITY OF ST. LOUIS AND OTHERS AND THE CEO'S MAKE MORE MONEY THAN BIG OIL DOES. THEY DO NOT HAVE ANY EXPLORING FEES. THEY DO NOT MOVE OIL OR REFINE OIL BUT THEY CAN HURT PEOPLE IN THIER CARE. AND NEVER FEEL BAD. THEY JUST WANT THE MONEY. DO YOU THINK DEATH BOTHERED STEVE OR HIS C.E.O. BODDIES WHEN OTHERS WERE DYING AND SUFFERING. GOD LOVES HIS CHILDEREN.
AND SATAN LOVES THE REST HERE IN HELL ON EARTH. GODS WITNESS.

podalirios 12:12:02 AM Aug 27 2007

Report This!

HOW ABOUT IF MEDICARE AND MEDICAID STOP PAYING FOR THE ILLNESSES THAT PATIENTS INFLICT UPON THEMSELVES? THAT WOULD INCLUDE MOST CASES OF LUNG CANCER, SKIN CANCER, AIDS, VD,CHRONIC OBSTRUCTIVE PULMONARY DISEASE, MANY CASES OF CIRRHOSIS OF THE LIVER, AND HEPATITIS, SEIZURES CAUSED BY ALCOHOL WITHDRAWAL, PARALYSIS CAUSED BY MOTORCYCLE ACCIDENTS OF PEOPLE WITHOUT HELMETS, LOTS OF CASES OF VIOLENCE, OF WHICH MANY ARE SEEN IN ER'S AND HOSPITALS. AND HOW ABOUT THE PEOPLE WHO COME IN JUST BECAUSE THEY WANT TO BE CHECKED TWICE? DON'T PAY FOR THAT, EITHER. LOTS OF COST SAVINGS! A LOT OF PEOPLE ON MEDICARE AND MEDICAID ARE SPENDING THEIR OWN MONEY ON GOLF, CRUISES, BOOZE AND CIGARETTES. WHY SHOULD THE REST OF THE NATION BE FORCED TO PAY THEIR MEDICAL BILLS- INCLUDING THE WORKING POOR?

BFTQPON 11:24:00 AM Aug 22 2007

Report This!

TO DIVINEMSLIN:

BEEN THERE DONE THAT, ..I WORKED WITH STAFF WHO DID NOT CARE ABOUT THE PATIENTS BUT THE PAYCK AT WEEKS END. I COMMEND YOU FOR DOING YOUR JOB AND CARING ABOUT THE PATIENTS NEEDS.

I ALSO GOT BURNED OUT BY THE JOB STRESS OF WORKING MY ASS OFF AND NO ONE ELSE DOING ANYTHING AND COMPLAINING ABOUT PATIENTS NEEDS WHEN THATS WHAT THEY WERE HIRED FOR....MANGEMENT NOT DOING ANYTHING TO HELP THE SITUATION.. SO YES, FOR THOSE OF US WHO DO THE JOB OF CARING FOR OTHERS... BURN OUT IS FAST AND SWIFT AND THE PATIENTS SUFFER FOR IT.

divinemslin 11:03:16 AM Aug 22 2007

Report This!

As a just retired nurse.. I look at it differently. catheters are left in too long and for the wrong reasons. for the convenience of the nurses and aides. Patients fall because they are over medicated and not observed often enough for the convenience of the nurses and aides. I cant tell you how many aides have asked me for catheters and for the patient to be given sleeping pills and such, for their convenience. And when I refused to do what they asked, my patients would be left in a soaked bed , which I changed myself. Inflitrated IV sites.... supposed to observe every two hours. but most nurses chart but dont actually go in and look. I advise you to have someone stay with a patient if possible.. dont expect to be waited on but do speak up if your loved one has not been turned or encouraged to cough and deep breathe. and have the nurse explain what every single pill is for. and the dosage............ Just my opinion as a burnt out nurse.

nflamingo 06:48:34 PM Aug 21 2007

Report This!

Hospitals want to make money......................Ins. Companies want to save money

We are all in a NO WIN situation

BFTQPON 06:12:00 PM Aug 21 2007

Report This!

CAROLYN9M: YOU ARE SO RIGHT PLUS THE ALMIGHTY DOLLAR.

INSURANCE COMPANYS . WANT TO SEND PEOPLE HOME THE SAME DAY AFTER MAJOR SURGERY, YET I BET IT HAS NOT OCCURED TO THEM THAT THEY SPEND MORE ON ER VISITS AFTER SENDING A PT HOME AFTER A PROCEDURE. THAN BY ALLOWING THE PT TO BE MONITORED OVERNIGHT OR A DAY OR TWO EXTRA.

BFTQPON 06:05:00 PM Aug 21 2007

Report This!

THE HOSPITALS SHOULD NOT HAVE THESE OCCURENCES HAPPEN, BED SORES ETC AS MENTIONED IN THE ARTICLE. OUR NURSING STAFF IS UNDERPAID AND OVERWORKED AND THEIR TRAINING NEEDS TO BE CONTINUED AS MEDIICAL CARE CHANGES......ALSO PERHAPS MEDICARE SHOULD NOT GIVE SO FREELY TO ILLEAGLES WITH A LOAD OF KIDS AND MORE KIDS THAT DRAIN RESOURCES TO AMERICAN CITIZENS, WE AS AMERICANS SHOULD NOT HAVE TO WAIT YEARS FOR COVERAGE WHILE ILLEAGLES GET COVERAGE AS SOON AS THEY ENTER THE USA.

carolyn9m 12:03:00 PM Aug 21 2007

Report This!

That may work for the patient who has a longer stay, but what about those who are thrown out the door the same day? There hasn't been time to detect an infection, and those are the things that create the most serious problems.Will have to say tho that most serious problems I've heard of were to those who had the longer stays and that possibly could have been prevented. Personal hygiene of the staff and personel is hard to monitor as is the housekeeping and everyone else involved with the running of a hospital.

1 - 10 of 2541

2541 comments