Re: Medicare Says It Won't Cover Hospital Errors
From: Gerald P.Rodriguez (geraldpr@cybermesa.com)
Fri Aug 24 16:42:21 2007
No, not the Medicare patient. That cost will just be put back onto the
hospital who will skinny down on ancillary staff and putting whatever it can
on the patients with private insurance.
Gerald P. Rodríguez, M.D., FACOG
Santa Fe
>----- Original Message -----
From: "art fougner, md" <evsono@pipeline.com>
To: "Multiple recipients of list OB-GYN-L" <ob-gyn-l@dns.obgyn.net>
Sent: Friday, August 24, 2007 12:20 PM
Subject: Re: Medicare Says It Won't Cover Hospital Errors
> So CMS ... who's gonna foot the bill? The Patient?
>
> Art
>
> At Fri, 24 Aug 2007, Henry Gregor wrote:
>>
>>Nothing new under the sun....years ago, as a resident, I recall reading a
>>Medical Society of Virginia Journal article looking at the costs of
>>monitoring and review of fraud and found a huge expensive differential of
>>costs vs uncovered fraud. Predictably the response was that absent a
>>surveillance program there would have been lots of fraud that awareness of
>>the program prevented. Flawed argument however, as much of the data
>>reviewed had accumulated before the review process went into effect. Don't
>>expect anyone to share Anna's concerns, or use past history...kinda' like
>>being "tough of crime"...very good for demagoguing the electorate.
>>
>> Hank
>>
>>"Anna Meenan, MD" <annam@uic.edu> wrote:
>> 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&oref=slogin
>>
>>---------------------------------
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>>
>>--
>>
>
> --
> art fougner, md
> "May The Wings of Liberty Never Lose a Feather." - Jack Burton
>
