Medical Errors: Who Will Pay?
In an attempt to save millions of dollars in health care costs, a new policy recently announced by the Bush administration states that Medicare will no longer pay the extra costs of treating "preventable errors, injuries, and infections." Private insurers are also considering changes which they say could save them money and benefit patients.
Conditions for which Medicare will no longer reimburse additional charges include, among others, pressure ulcers (bed sores), infections resulting from prolonged use of blood vessel and urinary catheters, injuries resulting from falls, and preventable events due to negligence, such as sponges or other objects left behind in surgery.
Most of these new rules seem reasonable, even necessary, especially withholding payment to hospitals if they fail to control preventable infections. The widespread distribution of methicillin-resistant staph aureus (MRSA) over the past three decades is a national disgrace. Among developed countries, the United States has one of the worst records for curbing, not only MRSA, but other drug-resistant infections. The CDC itself noted a 32-fold increase in MRSA hospital infections between 1976 and 2003. 25 years ago Denmark, Finland, and the Netherlands faced similarly soaring rates of MRSA, but have nearly eradicated it. See this.
Stopping Medicare payment for extra care resulting from preventable errors seems to make obvious good sense, and patients undoubtedly should benefit. Will the costs be balanced by reducing hospital stays, fewer misadventures and deaths? Let us fervently hope so.
Yet, with profound changes in reimbursement there are always unforeseen consequences. Hospitals and physicians will have to perform additional testing (much of it in retrospect will prove unnecessary), documentation and internal auditing will explode, more employees hired, more lawyers consulted, more hospital bureaucracy and finger-pointing. And more malpractice suits?
What about infections and other conditions already present when the patient is admitted? How to prove the hospital is at fault? Moreover, serious complications, occur even when physicians and nurses take all the recommended precautions. Will the new Government rules stop payment for extra care and hospital days in every diabetic, cancer or dialysis patient, or post-op case of infection? What about patients at the end of life prone to pressure sores no matter how well they are cared for? Will every confused patient have to be in restraints for fear he or she will fall out of bed and sustain a fracture? Then there is the (imagined?) danger that unscrupulous hospitals will attempt to charge patients for charges Medicare refused to pay. Note: the law clearly states, "The hospital cannot bill the beneficiary for any charges associated with the hospital-acquired complication."
There's more, so stay tuned.
Martin F. Sturman, MD, FACP
Copyright 2007, Mathemedics, Inc.
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