Hospitals ready for hit from new Medicare rules

Federal payments will end for care related to medical errors

By Peter Korn

The Portland Tribune, Aug 8, 2008, Updated Oct 30, 2009 (8 Reader comments)

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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.

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