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Medicare shouldn’t pay when hospitals hurt patients

Wednesday, June 13, 2007

Consumers Union Supports Proposed Medicare Rules Aimed at Reducing Hospital Infections & Medical Errors
Medicare Considers Withholding Payments to Hospitals When They Fail to Keep Patients Safe

WASHINGTON, D.C. – The federal government should move forward to restrict Medicare payments to hospitals for the cost of healthcare associated with certain infections and medical errors acquired during treatment, according to Consumers Union, the nonprofit publisher of Consumer Reports.
In comments submitted to the Centers for Medicare and Medicaid Services (CMS) today, the consumer group said that a proposal by the agency to limit such payments would provide hospitals with a powerful incentive to improve patient care. Consumers Union urged CMS to strengthen the proposed regulations by expanding the types of infections that would result in lower Medicare payments and to include protections to ensure patients are treated fairly and get the care they need.
“On average, ten Americans die from hospital-acquired infections every hour,” said Lisa McGiffert, Director of Consumers Union’s Stop Hospital Infection’s campaign (www.StopHospitalInfections.org). “The infections covered by this proposal are all too common and carry a hefty price tag for this public healthcare program. This proposal will save money and lives by motivating hospitals to strictly follow long-standing infection prevention guidelines that are too often ignored.”
Under the proposed regulations, Medicare would withhold payments to hospitals for care associated with treating certain urinary tract infections, staph aureaus bloodstream infections, and four other medical errors unrelated to infections (bed sores, objects left in patients’ bodies, blood incompatibility, and air embolism). In response to Congressional direction, CMS evaluated 13 healthcare acquired conditions and identified these six for the first round of non-payment due to the high volume of patients affected, the high cost of treating patients, or both. If adopted, the rules will go into effect in October 2008.
Consumers Union urged CMS to consider expanding its proposal by withholding payment for care associated with other infections caused by hospitals, including selected MRSA infections, surgical site infections, and vascular catheter-associated infections beginning in the first year, and for ventilator associated pneumonia starting in 2009. The consumer group also called on CMS to adopt strong protections to prevent hospitals from billing patients when Medicare payments are withheld, and to prohibit hospitals from avoiding patients perceived to be at risk for infections.
Hospital acquired infections are a leading cause of death in the United States. The Centers for Disease Control and Prevention (CDC) recently estimated that 1.7 million patients suffer from hospital infections every year and nearly 100,000 of them die. Research shows that hospitals could prevent many infections if they consistently followed proven infection control practices.
The financial costs associated with hospital infections are equally staggering. Dr. John A. Jernigan, Chief of Interventions and Evaluations at the CDC, has said that hospital acquired infections result in up to $27.5 billion in additional healthcare expenses annually. Medicare foots the bill for a big portion of infection-related healthcare costs. A 2005 report by the Pennsylvania Healthcare Cost Containment Council found that Medicare was billed for 67 percent of the total number of patient infections reported by the state’s hospitals.
“Taxpayers spend billions of dollars every year covering the cost of patient infections,” said McGiffert. “Restricting Medicare payments for medical errors like patient infections will help ensure that the healthcare taxpayers pay for is safe and effective.”
A copy of Consumers Union’s comment letter to CMS is available at:
Lisa McGiffert: 512-477-4431, ext 115