Re: Medicare Says It Won't Cover Hospital Errors
From: art fougner, md (evsono@pipeline.com)
Sun Aug 19 14:03:13 2007
It appears CMS has officially jumped the Shark.
Art
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
--
art fougner, md
"May The Wings of Liberty Never Lose a Feather." - Jack Burton
