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Medicare Says Not Liable For Hospital Infections Or Errors |
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Written by Theresa Maher
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Tuesday, 21 August 2007 |
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Patients who develop hospital infections like pressure ulcers will not receive Medicare payments to get treatment for the same, the Centers for Medicare & Medicaid Services (CMS) has announced. The measure is being seen as the Bush Administration's latest salvo in making Medicare an efficient health insurance organization.
According to the US Centers for Disease Control and Prevention, hospital infections "account for an estimated 1.7 million infections and 99,000 associated deaths each year. Among them
* 32 percent of all healthcare-associated infection are urinary tract infections
* 22 percent are surgical site infections
* 15 percent are pneumonia (lung infections)
* 14 percent are bloodstream infections
The CDC published these findings in the March-April 2007 journal, Public Health Reports. The report says the cost of treating hospital acquired infections is enormous as well.
In its latest statement Medicare said it was not liable for hospital acquired infections or errors by doctors and would not pay for the treatment of complications arising out of the hospital stay of patients. It said payments would not be made unless the condition was present prior to hospital admission. CMS said that eight "reasonably preventable" conditions will not be paid for by it.
These eight conditions include vascular-catheter-associated infections and mediastinitis, which is an infection that develops after major heart surgery. Also included in this list are injuries caused by patients’ falls in the hospitals and doctors leaving behind instruments or sponges following surgery. "Never" events like air embolisms and blood incompatibility are also included in this list.
Medicare said hospitals cannot charge for mistakes committed by staff or for infections that are developed there. Hence the costs of treating such complications will have to be borne by hospitals themselves.
Medicare added these measures would take effect from October 2008. there would be three more conditions added to this list, it said.
The health insurance arm of the US government added the new rules were possible because of the provisions in Deficit Reduction Act of 2005. This act has already been put into effect in many state health programs. Hospitals are reporting secondary diagnoses from October 1 this year.
The new measure received overwhelming support from advocacy groups. Lisa McGiffert, director of Consumers Union said this was a long-overdue step, "Every year, millions of Americans suffer needlessly from preventable hospital infections and medical errors," she pointed out. "These new rules are a good beginning for Medicare to use its clout to mobilize hospitals to improve care and keep patients safe."
CMS Acting Deputy Administrator Herb Kuhn said the steps were a part of the inpatient prospective payment system (IPPS), “With these changes – first proposed by the Medicare Payment Advisory Commission in 2005 – Medicare payments for inpatient services will be more accurate and better reflect the severity of the patient’s condition," he added.
"CMS will measure 30-day mortality for Medicare patients with pneumonia and plans to adopt two measures relating to surgical care improvement in the CY 2008 outpatient prospective payment system final rule. In addition, CMS will finalize two additional surgical care improvement measures by program notice after they receive NQF endorsement."
The new rules are an effort to reduce the cost of Medicare, which has risen to $408 million last year. Coupled with an aging population, the system is struggling to sustain itself for future generations. The new measures will make hospitals accountable for their errors and will reduce the burden on patients as well.
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