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Medicare Won't Reimburse Hospital Errors

Posted by Chrissie Cole
Monday, October 06, 2008 12:48 PM EST
Category: Major Medical
Tags: The Deficit Reduction Act of 2005, Medicare, Medical Errors, Medical Malpractice and Negligent Care, Hospital Errors, Never Events


IMAGE SOURCE: iStockPhoto / doctors circling / author: Kovalvs

The Centers for Medicare & Medicaid Services (CMS), the government insurance program for the disabled and elderly, will no longer reimburse hospitals for the extra cost of treating patients who are injured due to their own mistakes.

For decades hospitals have been reimbursed for their own mistakes and the cost to correct them. But now, the federal government is tired of doctors and hospitals profiting from their mistakes.

Medicare covers 12.5 million people annually. In 2007, Medicare spent $110 billion on inpatient care. Medicare has defined a list of “reasonably preventable” medical conditions due to health care errors and will no longer reimburse for these conditions.

Post operative infections, medication errors, blood transfusions, secondary operations as a result of leaving equipment inside of a patient during the first procedure, are just some of the reasonably preventable conditions that are listed.

Officials believe this new policy may apply to several hundred thousand hospitals annually and may have landmark implications because Medicare sets the standard for billing and reimbursement in the insurance industry.

The new policy will also prevent hospitals from billing Medicare patients directly for the reimbursement of preventable illnesses.

More than 100,000 people die each year in this country due to “never events,” described as errors in medical care that are clearly preventable and serious in consequence for patients. That number doesn’t include the long list of injuries caused by doctors and hospitals.

The Medicare system has long been met with opposition for failing to enforce better quality standards in the hospital’s it reimburses for care.

In addition to no longer reimbursing hospitals for the extra cost of treating patients who are injured due to their own mistakes, federal officials recently approved a new company to begin inspections as part of a hospital accreditation program.

DNV Healthcare will become the first new accreditor in more than three decades. The Joint Commission on the Accreditation of Healthcare Organizations has effectively held a monopoly on hospital reviews, until now, which is required in order to participate in Medicare.

In July 2005, Gilbert M. Gaul of the Washington Post, revealed widespread deficiencies in Medicare’s quality and oversight programs – Chronic Condition. Among findings, the Joint Commission collected millions of dollars from its accreditation program while rarely marking hospitals for inadequate care and missing cases in which patients were injured or killed, among other findings.

The Deficit Reduction Act of 2005 requires hospitals participating in the Medicare program to report preventable medical errors ranging from catheter infections to pressure sores caused by hospital workers, among other conditions.

Who Should Pay For Medical Errors?

Who will pay for the treatment necessary for these errors asks one reader of the New York Times. Is the patient left to pay for corrective treatments or to negotiate with hospital administration?

If hospitals are forced to provide free corrective treatment to victim patients, those costs will become part of hospital overhead, which we will essential pay for anyway, said Pepi Ross.

Another reader, Laura Weil, writes, “The power of the purse strings to improve patient safety provides powerful incentives to eliminate error-prone processes. However, most troubling, though, is that payment penalties will also increase the motivation for cover-ups.

"It is only through honest and open acknowledgement of errors that error patterns can be detected, corrective actions put in place and patient safety improved."

She worries that administrative finger pointing will make clinicians more inclined to cover their tracks when mistakes do occur.  #


Anonymous User
Posted by Jenifer
Monday, October 06, 2008 3:06 PM EST

I currently work as an RN for a loca hospital. They have really been pushing education onto their employees to make sure we understand that "we" (the hospital and staff) are responsible for the care of our patients. Documentation has become stricter as patients are being admitted, so that correct reimbursement can be made. If "we" are at fault, it comes out of the overhead, and eventually will be passed along to the other consumers. Hopefully the preventative measures the hospital has taken will help alleviate some of that hand-off.

Anonymous User
Posted by Jane Akre
Monday, October 06, 2008 3:42 PM EST


Thanks for telling us about what goes on inside hospitals. Real world examples are always welcome!

Comments for this article are closed.

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