Re: Medicare Says It Won't Cover Hospital Errors
From: Joe (forcep@intercom.net)
Fri Aug 24 19:42:19 2007
Hank: Never forget that there is a large lay segment of population out
there who are quite jealous of your abilities and want to control
everything you do through whatever means. Joe C
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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