Re: Medicare Says It Won't Cover Hospital Errors
From: Lynn Montgomery (apgar10@thebirthcentermt.com)
Thu Aug 23 12:13:17 2007
No different than Colorado implementing a policy of not providing
healthcare to individuals without proof of citizenship. Projected to
save approximately $300,000/yr, but will cost several million to
implement and maintain annually...
--
Lynn D. Montgomery, M.D.
Obstetrics & Gynecology, Maternal-Fetal Medicine
The Birth Center/Rocky Mountain Women's Health
1211 S. Reserve St.
Missoula, Montana, 59801
406-549-0978
fax 406-549-0987
e-mail: apgar10@thebirthcentermt.com
-----Original Message-----
From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of Anna
Meenan, MD
Sent: Thursday, August 23, 2007 10:11 AM
To: Multiple recipients of list OB-GYN-L
Subject: Re: Medicare Says It Won't Cover Hospital Errors
I read an article this morning that stated this program will save
Medicare $20 Million a year. The Medicare budget is $400 BILLION. That
means that medical errors cost 0.005% of the entire budget. (and the
auditors they hire to find the istakes will probably cost more than $20
mil. I'm wondering if there is any other industry where errors account
for that small a fraction of the total expenditures, and will this
program save money or just drive more hospitals into bankruptcy? If they
don't pay for care of decubiti, will hospitals lay off all their skin
care nurses? Does that mean we will see MORE decubiti? Lots of things to
think about here.
Anna Meenan, MD
At Sun, 19 Aug 2007, Dean Huffman . wrote:
>
>..
>
>Medicare Says It Won't Cover Hospital Errors
>
>By ROBERT PEAR [New York Times]
>
>Published: August 19, 2007
>
>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.
>
>"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."
>
>http://www.nytimes.com/2007/08/19/washington/19hospital.html?_r=1&hp&or
ef=slogin
