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Medicare won’t pay when hospitals harm patients

Friday, August 1, 2008

Medicare Expands Policy to Withhold Payments to Hospitals That Harm Patients

Non-Payment Plan Seeks to Spur Hospitals to Improve Patient Safety

WASHINGTON, D.C. – The federal government has decided to expand its effort to restrict Medicare payments to hospitals for the extra care required to treat patients harmed by certain preventable infections and medical errors. The policy announced by the Centers for Medicare and Medicaid aims to provide hospitals with a financial incentive to improve patient care.
“Medicare is sending a powerful message to hospitals that harming patients will harm their bottom line,” said Lisa McGiffert, Director of Consumers Union’s Stop Hospital Infection’s campaign (www.StopHospitalInfections.org). “This policy will help prevent needless suffering and deaths and ultimately ensure that the healthcare taxpayers pay for is safe and effective.”
Under the expanded policy, CMS will withhold payments to hospitals for care needed after patients suffer from certain surgical site infections (specifically for total knee replacement, laparascopic gastric bypass and gastroeneterostomoy, and ligation and stripping of varicose veins); deep vein thrombosis/pulmonary embolism (formation/movement of a blood clot); and extreme blood sugar derangement.
CMS had considered adding a number of other hospital acquired conditions to the nonpayment list: staphylococcus aureus septicemia (bloodstream infection); Clostridium difficile associated disease (a bacterium that causes severe diarrhea and more serious intestinal conditions such as colitis); Legionnaires’ disease (a type of pneumonia caused by a specific bacterium); Iatrogenic pneumothorax (collapse of the lung) delirium; and ventilator-associated pneumonia. However, none of these hospital acquired conditions were included in the final nonpayment rules just issued by the agency to be implemented on October 1, 2009.
“We are disappointed that Medicare has decided to continue paying hospitals when patients suffer from these other serious infections and medical errors,” said McGiffert. “We urge CMS to add these and other hospital acquired conditions to the nonpayment list in the future. In the meantime, hospitals need to improve their efforts to follow long-recognized patient safety practices that are too often ignored.” Consumers Union filed comments with CMS earlier this year urging the agency to include more hospital acquired conditions on the nonpayment list.
Last year, CMS adopted rules to begin the nonpayment policy for certain hospital acquired conditions beginning October 1, 2008. These initial nonpayment rules cover certain urinary tract infections, staph aureaus bloodstream infections, and four other hospital errors unrelated to infections: serious bed sores, objects left in patients’ bodies following surgery, blood incompatibility, and air embolism.
Lisa McGiffert: 512-477-4431, ext 115
Michael McCauley: 415-431-6747, ext 126