Re: Medicare Says It Won't Cover Hospital Errors
From: Meenan, Anna (annam@uic.edu)
Thu Aug 23 20:28:31 2007
That number doesn't seem right. $300,000 wouldn't cover very many
people. Does colorado really have so few non-citizens?
Anna Meenan, MD
>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
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