Hospitals ready for hit from new Medicare rules
Federal payments will end for care related to medical errors
Portland hospitals — as well as hospitals around the country — are girding for a hit to their bottom lines this fall, when the federal Centers for Medicare and Medicaid Services will stop paying the bills for care due to certain medical errors.
Last year, Medicare Services listed eight preventable conditions for which it would not make payments to hospitals beginning Oct. 1. Among those were a variety of infections, bed sores, objects left in patients' bodies following surgery, and giving patients the wrong blood.
This week, Medicare Services added to the list. At the top of the additions is surgical site infections, long a concern of patient advocates. Infections acquired during surgery often lead to huge treatment bills as well as severe complications for patients.
In addition, the new Medicare policies mean that deep vein thrombosis or pulmonary embolisms following knee and hip replacement surgery will not be reimbursed either.
The rules should help make hospitals more accountable for their care, according to Don McLeod, public affairs specialist at Medicare Services.
“In the past hospitals could actually be paid more for making mistakes,” McLeod said.
Coming to the rescue
Dee Dee Vallier, a Hood River patient safety advocate and member of an Oregon advisory committee on acquired infections, said the new rules should help keep patients safer. Vallier said she would have liked to see Medicare Services add even more complications to its list.
“More should have been done here, but I'm really glad (Medicare Services) is finally coming to the rescue of patients,” Vallier said. “It's going to send a very powerful message to the other insurance companies to also stop compensating the hospitals for the harm that they are causing.”
Private insurers are, in fact, looking at following Medicare's lead in not paying bills for care created by hospital mistakes, according to Maggie Huffman spokeswoman for insurer Health Net of Oregon.
“Not paying for avoidable medical mistakes certainly has merit,” Huffman said. “We intend not to reimburse for the same medical errors that (Medicare Services) has announced they will not pay for.”
Huffman said that Health Net is evaluating how to put such a policy in place for its members.
Angela Hult, spokeswoman for Regence BlueCross BlueShield of Oregon, said her company would also consider a policy of not paying for hospital mistakes. But Hult said a difficulty for insurers will be distinguishing which bills are attributable to preventable hospital mistakes.
What's the cost?
Exactly how much the new rules will cost Portland’s hospitals is hard to determine. The Tribune called administrators from Legacy Health System, Providence Health and Services and Oregon Health & Science University for comment, but they did not return calls.
Medicare Services has estimated that its total savings could amount to about $190 million over five years. Approximately 3,200 hospitals nationwide will be affected by the new payment policy.
A study released last week by the federal Department of Health & Human Services Agency for Healthcare Research and Quality found that one in 10 hospital patients who died within 90 days of surgery did so as a result of preventable hospital errors.
The study attached costs to many of the hospital mistakes for which Medicare will no longer accept billing. Insurers paid an extra $28,218 on average for surgery patients who experienced acute respiratory failure, according to the study. Patients who acquired infections had an average of $19,480 added to their bills.
But the real costs to hospitals will be much more than the unpaid care, according to Nancy Foster, vice president for quality and patient safety policy for the American Hospital Association in Washington, D.C.
Foster said that if hospitals are going to have to track complications such as sores and infections acquired during patient stays, they will need to do much more thorough diagnosis of all patients to determine if they have infections or sores upon arrival.
“We expect there will be an increase in testing and an increase in the amount of work a clinician will need to do when he or she admits a patient,” Foster said.
“That totally adds cost,” said Valerie Rinkle, revenue integrity director for Asante Health System, which operates Rogue Valley Medical Center in Medford.
Rinkle said that her hospital supports the reporting of serious adverse events, but disputes Medicare's refusing to pay for some of the complications on the list.
“We can do absolutely everything for a patient, but if that patient is malnourished or has some other things, no matter how good their care at the hospital, they can develop a bed sore. And Medicare is not taking that into account. We’re going to get less payment and get penalized,” Rinkle said.