Monday, August 20, 2007

Medicare won't pay for preventable conditions

Medicare, the largest health insurer in the U.S., has announced that it will not pay for 8 hospital conditions that could be preventable. Starting in October, 2008, if a patient enters a hospital and acquires these conditions, the hospital will not get reimbursed for the costs. The conditions that we doctors call "never-events" because they should never happen, are:
  • Urinary tract infection from a catheter
  • Blood infections from IVs or catheters
  • Pressure ulcers (bed-sores)
  • Retained objects after surgery ( a sponge or instrument left inside)
  • Air embolism
  • Blood incompatibility (from transfusions)
  • Mediastinitis (infections of the sternum that happen after heart surgery)
  • Falls (very common and hard to prevent)
The hospital industry has already started protocols and procedures to prevent these conditions but it will take an all out effort by doctors, nurses, administrators and even families to make sure no patient has a "never-event".

I think this is good that Medicare is putting money on the problem. It will certainly get everyone's attention and drive safety and quality improvement to the next level.


Anonymous said...

What about the MANY patients who don't have insurance of any kind, who already pay far more than the insured do, (or insurance companies do) for the same services (insurance companies negotiate cheaper rates)

Will patients be left holding the bag for these injuries? Could they lose their homes, cars, credit ratings, or other assets to collection agencies if Medicare will not pay?

For renters this could be a disaster because it would mean that they would not be able to rent again in many areas.

Rich said...


Toni Brayer MD said...

For Anon and Rich: Hospitals cannot bill the Medicare patients for these "never events" per Medicare rules. It is thought that private insurers will soon follow these Medicare guidelines and also deny payment.

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