Medicare Proposes Adding to Its List of Hospital-Acquired Conditions For Which It Will Not Pay the Extra Costs

The Centers for Medicare and Medicaid Services (CMS) is proposing to add an additional nine categories to its initial list of 8 preventable conditions that could reasonably have been avoided. that Medicare will no longer pay the extra costs of treating when acquired in the hospital.

In a statement dated April 14, 2008, CMS proposed to add the following to its list of preventable conditions that it will not pay for: Surgical site infections following certain elective procedures: Legionnaire’s disease; Extreme blood sugar derangement; Iatrogenic pneumothorax or collapsed lungs; Delirium; Ventilator-associated pneumonia; Deep vein thrombosis or pulmonary embolism; Staphylococcus aureus septicemia or bloodstream infection; and Clostridium difficile associated disease.

In addition, CMS is proposing to create new codes to better identify two preventable conditions that were previously selected: foreign object retained after surgery; and pressure ulcers. The initial rule, which became effective on October 1, 2007, 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.

Three of these conditions are sometimes called never events, which are: objects left in a patient during surgery, blood incompatibility, and air embolism. Significantly, under the rules, the hospital cannot bill the beneficiary for any charges associated with the hospital-aquired complication.

Comments on the proposed rule will be accepted through June 13. CMS will respond to comments in a final rule to be issued on or before August 1, 2008.

Below follows interesting statistics (ie. number of cases and cost of each hospital stay resulting therefrom) found on the CMS website: THE INITIAL 8 Foreign Object Retained After Surgery 750 cases $63,631/hospital stay Air Embolism 57 cases $71,636/hospital stay Blood Incompatibility 24 cases $50,455/hospital stay Stage III & IV Pressure Ulcers 257,412 cases $43,180/hospital stay Falls and Trauma: 193,566 cases[5] $33,894/hospital stay
– Fractures
– Dislocations
– Intracranial Injuries
– Crushing Injuries
– Burns
– Electric Shock Catheter
-Associated Urinary Tract Infection (UTI) 12,185 cases $44,043/hospital stay Vascular Catheter
-Associated Infection 29,536 cases $103,027/hospital stay Surgical Site Infection
-Mediastinitis after Coronary Artery Bypass Graft (CABG) 69 cases $299,237/hospital stay

THE NEW NINE Surgical Site Infections Following Elective Procedures:
– Total Knee Replacement 539 cases $63,135/hospital stay
– Laparoscopic Gastric Bypass and Gastroenterostomy 208 cases $180,142/hospital stay
– Ligation and Stripping of Varicose Veins Total Knee Replacement 3 cases $66,355/hospital stay

Legionnaires Disease 351 cases $86,014/hospital stay Glycemic Control:
– Diabetic Ketoacidosis 11,469 cases $42,974/hospital stay
– Nonketotic Hyperosmolar Coma 3,248 cases $35,215/hospital stay
– Diabetic Coma 1,131 cases $45,989/hospital stay
– Hypoglycemic Coma 212 cases $36,581/hospital stay
– Iatrogenic Pneumothorax 22,665 cases $75,089/hospital stay Delirium 480 cases $23,290/hospital stay
– Ventilator-Associated Pneumonia (VAP) 30,867 cases $135,795/hospital stay
– Deep Vein Thrombosis (DVT)/Pulmonary Embolism (PE) 140,010 cases $50,937/hospital stay
– Staphylococcus aureus Septicemia 27,737 cases $84,976/hospital stay – – Clostridium difficile-Associated Disease (CDAD) 96,336 cases $59,153/hospital stay.

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, 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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