Medicare Won't Pay for Hospital Mistakes

[Purveyor]

Source: Associated Press

(08-18) 13:14 PDT WASHINGTON, (AP) --

Medicare will stop paying the costs of treating infections, falls, objects left in surgical patients and other things that happen in hospitals that could have been prevented.

--
The rule identifies eight conditions — including three serious types of preventable incidents sometimes called "never events" — that Medicare no longer will pay for.

Those conditions are: objects left in a patient during surgery; blood incompatibility; air embolism; falls; mediastinitis, which is an infection after heart surgery; urinary tract infections from using catheters; pressure ulcers, or bed sores; and vascular infections from using catheters.

--
Hospitals in the future will be expected to pick up the cost of additional treatment required by a preventable condition acquired in the hospital


Read more: http://sfgate.com/cgi-bin/article.cgi?f=/n/a/2007/08/18/national/w131415D18.DTL

[annabanana]

1. This makes sense, . . But why do I suspect that the costs will

end up being piled on the poor victim of said mistake... Or the Hospital will refuse to remove the utensil that's been left behind....

[youngdem]

4. The hospitals will refuse to treat it until the case is litigated

The patient will die or get worse or get permanently disabled, will have to hire a lawyer, the lawyer will win the case, take 40% and the patient will be left to treat a two year old injury or illness with 60% of the funds a court thought they might need, which is almost certainly too little, then the patient has to find medical care at a hospital different from their neighborhood hospital because who wants to take the risk of getting treated by someone you just sued.

OR

We could keep things as they are, realize that we ALL pay for situations like this in the end, hire more oversight experts to make rounds at hospitals to reduce incidents like this, and have a policy to pay for care regardless of fault in order to assure continuity of care.

Nah, that's crazy talk. Much better to make the patient suffer for the actions of doctors, bureaucrats and lawyers.

[aquart]

6. OR we could institute universal healthcare

And take care of the problem no matter what the cause. You know, No Fault Health Care.

[youngdem]

18. I wholeheartedly agree

I also favor the same thing for auto insurance.

Just add a few cents to gas per gallon, and make ALL accidents no fault. If someone gets in too many accidents, take their license.

This way, you take all of the games out of claims, and take the rip off out of private insurance...like credit-based pricing for premiums, rejection of coverage based on stupid conditions and screwing the poor by charging more for liability insurance in poor neighborhoods.

[lastliberalintexas]

23. Or, the patient could have trouble even finding an atty

because of the tort reform measures enacted in several states limiting the damages recoverable by victims. The patient could still "die or get worse or get permanently disabled" but never actually receive any compensation for their damages. Their families might, since some attys might be willing to take the case post-death/disability, since the damages might be higher by then.

But I don't know a single med mal atty in Texas who would take a case in which an instrument was left in a patient, the patient suffered an infection, had to endure a second surgery and was forced to pay for the second surgery because Medicare/insurance refused. It just wouldn't be worth their time and money, with what little is recoverable these days.

[peacebird]

2. why is it I think the patient will be the one who suffers most here?

[bemildred]

3. Just make them all employees of the government.

Then you can fire them if they make too many mistakes.

[rainbow4321]

5. This will last til the AHA and AMA chime in and start to bitch

about losing $$$. Then the law will no doubt have endless loopholes inserted to the point where it has no teeth to it. Or the docs/hospitals will start re-wording things like foley cath related infections as having some other cause just so they can get there $$.

[Yael]

7. And there is sepsis. Odd they aren't addressing that...

[glowing]

8. Good... they should... their mistake, their cost. It will weed out the

incompetents Dr.s.

[Mojorabbit]

15. As a former nurse

I can tell you that infections can happen no matter how careful you are. I agree with other posters. The patient will be left high and dry.

[glowing]

19. Yes and no... Some infections are from poorer care... I have seen some

of those places.... Not changing a catheter properly will cause infections or attending to a person who is bed-ridden can cause bed sores..... I know hospital staff is overworked, but these days, who the hell isn't?

[lastliberalintexas]

24. Do you honestly think the hospital or doctor is going to absorb

the costs of additional treatment? LOL.

[dflprincess]

9. I don't understand the not paying for infections

sometimes they happen even when the proper procedures have been followed...especially with "bugs" that are resistant to antibioticss.

[California Griz]

17. Problem is

the hospitals too often don't do their job properly. I told the nurses 3 times something was wrong with my IV they did nothing. I came down with phlebitis and now my left arm is almost useless.

[KT2000]

10. Refusing to treat

will be the hospital's response.
Know a woman who just received a letter from out local and only hospital informing her that they will not treat her in the ER for a particular condition - uncontrolled intestinal bleeding. Guess it is their call what they treat or not.

I imagine patients with complicated medical situations could also be denied care if they think the lists mistakes could occur.
Hospitals do not take responsibility - they answer to the administration.

[1monster]

11. If the hospital receives public funds for treatment, then I believe by law they have

to treat anyone who comes to the ER for treatment...

[KT2000]

12. Yes - maybe they

are hoping the letter will keep her away no matter what.

[1monster]

13. She should take that letter to her County Commission and/or state agency...

[postulater]

14. Hospitals / surgeons should also pay for

disability after failed back surgeries. Then we might see the incidence of unnecessary surgeries decline.

[Pastiche423]

16. Are they f'ing insane? (Rhetorical question)

You go to the hospital and through no fault of your own, you get a pressure sore or a UTI and THEY WON'T PAY FOR IT?

[mourningdove92]

20. I work in a hospital.

And there is serious concern about how these new rules will be interpreted.
First of all though, let me say that the patient WILL NOT be charged for any care not paid by Medicare. The hospital will have to write off any charges that Medicare decides to "not approve".

This is the part that has hospitals concerned.

"Hospitals are to begin reporting secondary diagnoses present on the admission of patients starting with discharges on October 1. Then, starting exactly one year later, cases with these conditions would not be paid at the higher rate unless they were present on admission, the agency said."

Doctors will have to be very careful when dictating their History and Physical on all inpatient admissions. If the patient has ANY OTHER complaints in addition to whatever is justifying the admission, the doctor darn well better get it documented. For example, if someone is admitted for, lets say a problem with his or her pancreas, and that is the main reason for going to the doctor and being admitted to the hospital, but the patient does not think to mention to the doctor that he or she has had a cough for the last few days and the cough turns into bronchitis or worse during the admission, all of the care given because of the bronchitis would not be paid for.

I also noticed that at this time there is no mention of MRSA infections, but I'll bet that is right around the corner.

You have absolutely no idea the kind of mine fields health care has to tippy toe through when treating patients these days.

[rainbow4321]

21. Not to mention admission charting on the nurses' part

I spent 8 yrs in an acute care setting and saw hundreds come from nursing homes w/ UTI's from foley caths, skin breakdown in various stages, and other problems from being in LTC facilities. Not to mention that once my hospital started the policy of testing everyone for MRSA upon admit, they all ended up in contact isolation. I can see a fingerpointing game going on already..the hospital saying that the pt CAME with the infection/skin breakdown, therefore they have to be paid for treatment.

It will come down to the admission nurse's assessment having eighty million pictures taken of any bump/bruise/skin tear/red spot on each new patient's body (whether they are from an LTC facility or home)...urine samples being sent on admission to look for ANY abnormal results (whether they have a foley or NOT), and then tack on whatever other lab test that will show the pt had the problem prior to admit.

Hospitals are good at looking for loopholes, esp. when it involves getting their money.

I recently left the acute setting and started in an outpatient setting. I don't foresee myself ever wanting to return to an inpatient setting. Tired of shit rolling downhill to the bedside nurse level. Pencil pushing nurses who haven't done pt care in eons making decisions/new policies and it's the bedside nurse that has 4 new papers to fill out each shift or, in the case of our computer charting, assessment screens changing weekly (getting longer, never shorter).

Then we have the post-fall injuries...xrays to make sure everything is ok, broken hips,etc..Despite what some families/managment think, the floor nurse:patient ratio is NOT 1:1. It's not the ICU where we can sit in or right outside the patient's door/window and watch them 24/7. Hell, I've had totally oriented patients who have been told every 2 hours during nursing rounds PLEASE call me if you need to get up. Do they? Nope. They get up by themselves and say afterwards "thought I could make it, guess I should have listened and called". And away they go for xrays or they suddenly have new skin tears, bumps, bruises.


Bottom line: improve nurse:patient staffing ratio and you will have less infections/falls/complications!

[zanne]

26. Mine fields, indeed.

And both the hospitals and their patients have to tiptoe through them.

[ProudDad]

22. There's a solution for this

and most other Health Care issues -- Universal Single Payer Health Care for ALL...

We all finance each other -- the Docs and Nurses handle Health CARE issues...

=============================

http://www.house.gov/conyers/news_hr676_2.htm

Brief Summary of HR 676

· The United States National Health Insurance Act establishes an American national health insurance program. The bill would create a publicly financed, privately delivered health care system that uses the already existing Medicare program by expanding and improving it to all U.S. residents, and all residents living in U.S. territories. The goal of the legislation is to ensure that all Americans will have access, guaranteed by law, to the highest quality and most cost effective health care services regardless of their employment, income, or health status.
· With over 45-75 million uninsured Americans, and another 50 million who are under- insured, the time has come to change our inefficient and costly fragmented non health care system.

Who is Eligible

· Every person living in or visiting the United States and the U.S. Territories would receive a United States National Health Insurance Card and ID number once they enroll at the appropriate location. Social Security numbers may not be used when assigning ID cards.

Health Care Services Covered

· This program will cover all medically necessary services, including primary care, in patient care, outpatient care, emergency care, prescription drugs, durable medical equipment, long term care, mental health services, dentistry, eye care, chiropractic, and substance abuse treatment. Patients have their choice of physicians, providers, hospitals, clinics and practices. No co-pays or deductibles are permitted under this act.

Conversion To A Non-Profit Health Care System

· Private health insurers shall be prohibited under this act from selling coverage that duplicates the benefits of the USNHI program. Exceptions to this rule include coverage for cosmetic surgery, and other medically unnecessary treatments. Those who are displaced as the result of the transition to a non- profit health care system are the first to be hired and retrained under this act.

Cost Containment Provisions/ Reimbursement

· The National USNHI program will set reimbursement rates annually for physicians, allow for "global budgets" (annual lump sums for operating expenses) for health care providers; and negotiate prescription drug prices. The national office will provide an annual lump sum allotment to each existing Medicare region; each region will administer the program.

· The conversion to a not-for-profit health care system will take place over a 15 year period. U.S. treasury bonds will be sold to compensate investor-owned providers for the actual appraised value of converted facilities used in the delivery of care; payment will not be made for loss of business profits. Health insurance companies could be sub-contracted out to handle reimbursements.

Proposed Funding For USNHI Program:

· Maintaining current federal and state funding of existing health care programs. A modest payroll tax on all employers of 3.3%. A 5% health tax on the top 5% of income earners. A small tax on stock and bond transfers. Closing corporate tax loop-holes, repealing the Bush tax cut.

[raccoon]

25. Saw this in my local paper, buried in the back pages

by the "liberal" media.