Medicare to Stop Paying Hospitals for Medical Errors

 

Beginning today, October 1, Medicare will stop reimbursing hospitals for ten medical errors they have found are most likely preventable. This is an initial list with room to grow as the insurance group sees fit. These new regulations may apply to hundreds of thousands of hospitals covered by Medicare. Additionally, this will also keep hospitals from directly billing patients for costs accrued by medical errors.

The ten preventable conditions on Medicare’s list are:

  • Air embolism
  • Blood incompatibility
  • Catheter-associated urinary tract infection
  • Deep vein thrombosis and pulmonary embolism following total hip or knee replacement
  • Falls and trauma
  • Foreign object retained after surgery
  • Manifestations of poor blood sugar control
  • Stage 3 and 4 pressure ulcers
  • Surgical site infection following coronary artery bypass, and certain orthopedic and bariatric procedures
  • Vascular catheter-associated infection

Medicare is the country’s largest insurer, and it is thought that its refusal to pay for preventable conditions has influenced other public and private groups to adopt similar criteria. Four state Medicaid groups announced over the past year that they will not pay for as many as 28 “never events.” Other commercial insurers like Aetna, Blue Cross Blue Shield, Cigna, and WellPoint in seven states have followed suit.

Pay-For-Performance

Experts don’t believe this to be a measure that will lead to large savings. However, there has been political pressure building for years on ways to revamp the medical payment system. Critics have said costs have been driven up through “perverse incentives that reward the quantity of care more than the promotion of health.” It is hoped that this can be reoriented into something called “pay-for-performance.”

Because the Medicare Payment Advisory Commission has recommended reducing payments to hospitals with high readmission rates, the focus is now on rewarding hospitals that do things correctly. Medicare grants bonuses to doctors and hospitals when they report quality control measures, and is experimenting with rewarding doctors who follow protocols for illnesses such as congestive heart failure, coronary artery disease, and diabetes.

Other recommendations, such as hand-washing, installing electronic prescribing systems to cut down on medication errors, nurses providing more information on patients during shift changes, and marking drugs like Heparin with labels to avoid drug mix-ups are already in place.

At Regions Hospital in St. Paul, Minnesota, hospital president Brock D. Nelson, states that there used to be an acceptance of many of these errors. “We’ve come to now accept that they’re avoidable. And that’s a sea change.”

If you or a loved one has been injured or sickened due to a medical error, please contact an experienced medical malpractice attorney in your area.