Article by INDYSTAR Reporter David Lee
Medicare says it might no longer pay for many of the mistakes made by hospitals. Medicare might cease paying for certain conditions acquired by a patient after he or she is admitted to a hospital. Among the proposed conditions to be dropped are:
1. Catheter-associated urinary tract infections.
2. Bed sores.
3. Objects left in after surgery.
4. Air embolism, or bubbles, in bloodstream from injection.
5. Patients given incompatible blood type.
6. Bloodstream staph infection.
7. Ventilator-associated pneumonia.
8. Vascular-catheter-associated infection.
9. Clostridium difficile-associated disease (gastrointestinal infections).
10. Drug-resistant staph infection.
11. Surgical site infections.
12. Wrong surgery.
Late next year Medicare plans to stop paying hospitals for costs incurred from some of the most common and preventable medical errors suffered by patients. It could be getting a bloodstream infection from a caretaker not thoroughly washing his or her hands. Or it could be developing a dangerous bed sore because a patient's skin was not inspected or cleaned as recommended.
The proposed change could have a far-reaching impact because Medicare is the largest single payer of medical bills in the nation. Commercial health insurers, such as Anthem Blue Cross and Blue Shield, often follow Medicare's lead when determining their own reimbursement policies.
"It is something we will want to look at and try to follow," said Eric Schmitz, director of provider contracting for Anthem. However, he added that Anthem is waiting to see how the final policy looks before making any decisions. The Federal Centers for Medicare and Medicaid Services, which operates Medicare, is taking public comment on the proposal through June. The changes are scheduled to take effect in October 2008.
Medical mistakes are deadly and expensive. Infections acquired in hospitals account for about 90,000 deaths and $4.5 billion in extra spending each year, according to the U.S. Centers for Disease Control and Prevention.
Preventing such problems is an ongoing effort among hospitals, doctors and organizations focused on health-care quality.
The Indiana Patient Safety Center was formed last year to help hospitals develop reliable systems to prevent harm to patients. Indiana also has a mandatory medical-error reporting system requiring that hospitals disclose certain mistakes, such as objects left inside a patient during surgery.
But unlike many other efforts, Medicare's proposal holds the potential to hit hospitals in their pocketbooks by changing the way they are paid for providing care. Under the change, hospitals no longer would receive payment for costs stemming from certain complications if those conditions did not exist when the patient was admitted into the hospital.
Medicare is looking at 13 specific conditions that include everything from urinary-tract infections related to catheters to a patient receiving an incompatible blood type during a transfusion.
The CDC reports more than 561,600 catheter-associated urinary tract infections a year, according to Medicare's proposal. In 2006, 11,780 Medicare patients had the infection as a secondary diagnosis during a hospital stay.
According to Medicare, those infections add an estimated $676 to a hospital bill. Some hospital-acquired conditions can be much more expensive.
The cost of treating pressure ulcers, or bed sores, can run anywhere from $500 to $40,000 a patient, according to the Institute for Healthcare Improvement. In 2006, 322,946 Medicare patients had a pressure ulcer as a secondary diagnosis.
St. Vincent Health, which operates hospitals across Indiana, said the proposed Medicare changes are in line with other initiatives to improve patient safety.
The American Hospital Association, which represents almost 5,000 hospitals and other health-care providers, said it welcomes efforts by Medicare and others to reduce errors and improve health-care quality.
"There's not a doctor or nurse who comes to work in the morning and wants to make a mistake," said Carmela Coyle, the AHA's senior vice president of policy. "I don't see nonpayment as an incentive to try to do better." She also said it is important to make sure that the conditions included in the Medicare policy change are indeed preventable and in control of the hospital.
Article by INDYSTAR Reporter David Lee