Medicare to Stop Paying Hospitals Extra to Treat Their Preventable Errors

Medicare, in a significant policy change, will no longer pay the extra costs of treating preventable errors, injuries and infections that occur in hospitals, which the government says could save lives and millions of dollars.

Under the new rule, effective October 1, 2007, and applicable to discharges occurring on or after that date, Medicare will not pay hospitals for the costs of treating certain conditions that could reasonably have been prevented. Significantly, under the new rules, the hospital cannot bill the beneficiary for any charges associated with the hospital-acquired complication.

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, or about 270 a day. The rule identifies eight conditions that Medicare no longer will pay for. Those conditions are: pressure ulcers, or bed sores; objects left in a patient during surgery; in-hospital falls; blood incompatibility, such as giving patients the wrong blood type; air embolism, or bubbles of air or gas entering the bloodstream during medical procedures; mediastinitis, which is an infection of the area between the lungs after heart bypass surgery; urinary tract infections from using catheters; and vascular infections from using catheters.

These conditions include three serious types of always preventable incidents, sometimes called “never events”, which are: objects left in a patient during surgery, blood incompatibility, and air embolism. The Centers for Medicare and Medicaid Services said it also would work to add three more conditions to the list next year. Private insurers are considering similar changes.

Hospitals are to begin reporting secondary diagnoses present on the admission of patients starting with discharges on October 1. Then, starting exactly one year later, cases with these conditions would not be paid at the higher rate unless they were present on admission.

The authority to promulgate the new rules comes from an Act of Congress in 2006 that gave the Centers for Medicare and Medicaid Services the power to prevent Medicare from giving hospitals higher payment for the extra costs of treating a patient when infections and other preventable conditions occur during a hospital stay. Consumer advocates are hailing the rules and Medicare’s willingness to use its clout to improve care and keep patients safe.

Michigan is one state that has had great success with systematic efforts to follow well-established infection-control practices to reduce infection rates in intensive care units. Hospital executives said these techniques had saved 1,700 lives and $246 million by reducing infection rates in intensive care units since 2004.

If you believe that you or a loved one has been a victim of medical malpractice at a hospital, including suffering pressure ulcers, or bed sores, an object left in a patient during surgery, a fall, a blood transfusion error, an air embolism, an infection of the area between the lungs after heart bypass surgery, a urinary tract infection or vascular infection from using catheters, or other complication, please contact the medical malpractice lawyers at Levine & Slavit. We have offices in Manhattan and Long Island, handling cases in New York City, the Bronx, Brooklyn, Queens and surrounding areas.

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