Re: Medicare Says It Won't Cover Hospital Errors
From: art fougner, md (evsono@pipeline.com)
Fri Aug 24 18:18:40 2007
It seems as though the market is set-up for the equivalent of airline
flight insurance to cover the cost of any untoward development.
Art
At Fri, 24 Aug 2007, Gerald P.Rodriguez wrote:
>
>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
>>>
>>>---------------------------------
>>>Pinpoint customers who are looking for what you sell.
>>>---------------------------------
>>>---------------------------------
>>>---------------------------------
>>>---------------------------------
>>>---------------------------------
>>>---------------------------------
>>>--0-1810869095-1187974194=:3767
>>>
>>>--
>>>
>> --
>> art fougner, md
>> "May The Wings of Liberty Never Lose a Feather." - Jack Burton
>>
--
art fougner, md
"May The Wings of Liberty Never Lose a Feather." - Jack Burton
