Today Medicare stops paying if patient is victim of doctor or hospital errors.

[madfloridian]

I read this several times because I could not believe it was happening. I expect the usual influx of insurance bloggers to come here and correct me and tell me that after all....insurance should not pay for the mistakes of the medical profession. It happened yesterday when I posted about Florida's needy and the groveling they have to do to get healthcare. A "voice of reason" from the insurance agency arrived here quickly to set me straight.

Included on the list are those who are victims of

"incompatible blood transfusions, develop infections after certain surgeries or must undergo a second operation to retrieve a sponge left behind from the first. Serious bed sores, injuries from falls and urinary tract infections caused by catheters are also on the list."

There's really not much more to say about this, except to wonder where are our party leaders speaking out on this. It is a congressionally mandated measure, and our Democrats control the congress.

Medicare Won’t Pay for Medical Errors

ST. PAUL — If an auto mechanic accidentally breaks your windshield while trying to repair the engine, he would never get away with billing you for fixing his mistake. On Wednesday, Medicare will start applying that logic to American medicine on a broad scale when it stops paying hospitals for the added cost of treating patients who are injured in their care.

Medicare, which provides coverage for the elderly and disabled, has put 10 “reasonably preventable” conditions on its initial list, saying it will not pay when patients receive incompatible blood transfusions, develop infections after certain surgeries or must undergo a second operation to retrieve a sponge left behind from the first. Serious bed sores, injuries from falls and urinary tract infections caused by catheters are also on the list.

Officials believe that the regulations could apply to several hundred thousand hospital stays of the 12.5 million covered annually by Medicare. The policy will also prevent hospitals from billing patients directly for costs generated by medical errors.

Because Medicare is the largest insurer in the country, its decision to refuse payment for preventable conditions has already influenced others — public and private — to set similar criteria.

Here's the part of the article that is very telling. It indicates it is more of a symbolic gesture in the long run than a real money saver.

The Congressionally mandated Medicare measure is not projected to yield large savings — $21 million a year, compared with $110 billion spent on inpatient care in 2007. But it carries great symbolism in the Bush administration’s efforts to revamp the country’s medical payment system, which has long been criticized as driving up costs through perverse incentives that reward the quantity of care more than the promotion of health.

So instead of "rewarding" the guilty party/parties for mistakes in treating a patient...they are going to just not pay.

They are thus making the patient pay for the mistakes of others. Talk about "perverse." (To make clear...though they may not actually be able to charge the patient for their errors I doubt that as much tender loving care would be given as would if there were reimbursement involved.) (On edit to make clear.)

I believe that fewer doctors will accept Medicare patients as the plan continues to set so many limitations. It is getting harder to find doctors who accept Medicare now. And Medicaid almost out of the question.

They have been trying to covertly privatize Medicare, and few have spoken out about it. Seniors get all these mailings that make them think they have to choose a new plan, when in reality they can just stay on traditional Medicare. No one is explaining this clearly to them.

One of those companies is now in receivership in Florida. Several went bust last year, and local clinics and doctors had to pick up the slack to the detriment of their existing patients. Suddenly longer wait times for appointments for their regulars.

Here is more about that from last year.

About 8000 seniors may lose Medicare coverage in one county.

WASHINGTON, May 6 — Insurance companies have used improper hard-sell tactics to persuade Medicare recipients to sign up for private health plans that cost the government far more than the traditional Medicare program, federal and state officials and consumer advocates say.

Insurance agents, spurred in some cases by incentives like trips to Las Vegas, have aggressively marketed the private plans, known as Medicare Advantage plans. Enrollment in them has skyrocketed in the last year, and Medicare officials foresee continued rapid growth in the next decade.

....."But Dr. Barbara L. McAneny, a cancer specialist in Albuquerque, said that many of her patients who signed up for such plans “suddenly found that they had huge new co-payments — $1,250 every three weeks for a combination of five intravenous chemotherapy drugs.”

In Florida and seven other states, the Universal Health Care Insurance Company offers a private fee-for-service plan that promises “the ultimate freedom to see any doctor, any time, anywhere.” This product — the Any, Any, Any plan — got off to a fast start, enrolling 85,000 people. But it “temporarily postponed new enrollments as of Feb. 14” because of a dispute with the Florida insurance commissioner, Kevin M. McCarty, who said the company did not have adequate cash reserves to comply with state law.

In one county alone:

LAKELAND - Polk County residents enrolled in Universal Health Care's Medicare Advantage plans can't expect any extra help from the federal government as they deal with a dwindling number of local physicians who accept the Universal plans.

The federal government isn't ready to schedule a special enrollment period for Polk residents who want to leave Universal, but officials continue to monitor the situation, a representative for the Centers for Medicare and Medicaid Services (CMS) said Monday.

U.S. Rep. Adam Putnam's office got the message from CMS and passed it to Central Florida Physicians Alliance, which represents 190 physicians who contracted with Universal through the alliance. That contract is being terminated at the end of May, which will force some Polk residents to find different doctors.

More than 8,000 Polk County residents are enrolled in Universal programs, company spokesman Bob O'Malley said.

They have been turning Medicare over to private companies right before our eyes, and they are not calling it that. They are making the traditional bedrock Medicare program so bad that soon doctors won't accept patients.


I have been called an idealist here often. Maybe I am. But how can it be justified to withhold treatment from a patient who is a victim of those who treat them?

[Telly Savalas]

1. 3rd paragraph of the second quoted passage

"The policy will also prevent hospitals from billing patients directly for costs generated by medical errors."

[madfloridian]

2. Yes, that makes it ok.

I guess. :shrug:

[madfloridian]

3. I clarified....I think the lack of payment will affect care that is needed.

It is hard enough now to get doctors to take Medicare patients.

[Barack_America]

11. It's more often hard to get doctors to accept Medicaid patients.

But Medicare is king. Threaten to cut off Medicare funds to a hospital and they will bend over backwards to prevent it. And that's what Medicare does. You either agree to their terms, or you can't treat their patients, which is a death blow to just about every doctor and hospital.

[Freddie Stubbs]

12. Not treating a medical condition they caused will open doctors and hospital to malpractice cliams &

possible loss of medical licenses. No reputable doctor or hospital is going to deny care due to a complication related to their care.

[madfloridian]

4. UPDATE: Hospitals already positioning to call "pre-existing" as possibility

And guess who will be caught in the middle of the fight that won't say that much money after all but speaks to Bush's ideology. :shrug:

Local Hospital Officials Question New Medicare Policy

But blame won't be as easy to place in some situations, representatives of local hospitals said, when asked about a new list of restrictions set out by Medicare.

The rules, which took effect Wednesday, say the government won't pay the added cost of specific, hospital-caused problems. Included on its list of "preventable conditions" are falls, certain types of infections, receiving incompatible blood, signs of poor blood-sugar control and some bedsores.

That's where the questions come in:

How do you know whether the patient had an undetected urinary tract infection before coming to a hospital for something else and only later being placed on a urinary catheter? Is it going to end up counting as an infection caused by that inserted tube?

Did someone have diabetes that wasn't causing symptoms or recognized before admission but began causing complications in the hospital?

And will the process of determining those pre-existing conditions cause doctors and hospitals to order excessive tests, resulting in more defensive medicine than already exists and leading to higher costs?

I don't blame the hospitals for fighting this rule. But no one seems to be speaking out or fighting for the patients rights.

[NNN0LHI]

5. If Dr. cuts my foot off and its the healthy one rather than the bad one the Dr. should not be paid

That makes complete sense to me.

Don

[madfloridian]

6. More things to think about...

http://www.syracuse.com/articles/healthfitness/index.ssf?/base/living-0/1222765000189610.xml&coll=1


"Big policy changes often result in unintended consequences. There are potential negatives that may result from the new policy.

As hospitals adjust to the loss of income, be aware of these possibilities:

Ö Patients may be tested more thoroughly before hospital admission to show whether they have infections or other problems before they arrive. This is defensive medicine, of no benefit to the patient, and only adds more charges to the bill.

Ö Hospital patients may be unnecessarily overmedicated with antibiotics to prevent infection, leading to pathogen resistance, causing future incidents of infections that cannot be treated.

Ö A patient may be discharged too quickly. If she needs to be readmitted later, then the hospital will test her to prove she arrived with the problem, and Medicare will pay for it anyway.

Ö Patients may be billed for additional out-of-pocket extras that aren't covered by insurance, and which may not be appropriate.

Should any of these problems happen to you, you'll want to report them to your insurer. It remains to be seen if we will have a way to fight them.

More information about Medicare's new "never events" policy can be found at http://tinyurl.com/neverevents08. "


Trisha Torrey is Every Patient's Advocate, host of University Hospital's HealthLink on Air radio program, and patient empowerment expert at About.com.
http://patients.about.com/od/patientempowermentissues/a/medicare08never.htm

[AllyCat]

7. Yeah. We had to switch to a different kind of Foley urinary catheter

that has an antibiotic in it (allergies???) that reduces the risk of infection by 50%. People get infections from catheters and that's that. It comes with the territory. We can clean the meatus with 5 gallons of betadine and it won't prevent all infections. It doesn't matter how frequently or infrequently we change them...people will still get infections. And now we won't get paid for their entire stay and treatment because of a urinary tract infection.

I agree that health care systems that screw up shouldn't be paid to fix their own errors, but I believe this goes too far.

[OPERATIONMINDCRIME]

8. "Will prevent hospitals from billing patients directly for costs generated by medical errors"

Sounds totally fair to me.

[Lance_Boyle]

9. Wha??? Doctors carry malpractice insurance to cover claims.

Patients' insurance (including medicare) should never be on the hook for malpractice claims - they're the ones FILING the claims!

[McCamy Taylor]

10. Bush has attempted to kill universal health care by making its model, Medicare, look bad.

The so called "Advantage Plans" that are paid more to provide less care to their cherry picked (and often illegally recruited) panel of super healthy elderly are where all the money is going now. These private plans are where Bush wants our tax dollars to go while those who need care can not get it.

There are also new incentives for doctors to deny care to Medicare patients. Be careful about these Mostly big groups where the government promises fat bonus checks if the docs meet certain criteria. Currently the gov't is not paying off the way it claimed it would.

The most likely intended consequence of this new law is that doctors will hesitate to treat the frail and poor elderly, since they are the ones who develop complications. Rich older people, with excellent nutrition, who have lots of family support (they can afford a stay at home daughter to care for them or even pay for a skilled attendant if necessary) or who are completely independent will breeze in and out of the hospital. It is the slightly senile, under nourished, poor, socially marginalized elderly who are most likely to arrive at the hospital without a round the clock family member to sit at the bedside. They are the ones who will climb out of bed at 3 am and slip and fall and break something. Or get a bedsore. Or not go to the bathroom because they are scared or not call for water often enough and therefore get a UTI.

Families should always have round the clock sitters with their elderly relatives in the hospital, same as you would with a child, if you want them to make it out in one piece. It helps to keep them from getting so confused, too. Family members can take turns. You will be glad you did.

[madfloridian]

13. Exactly. They have lessened Medicare until it is not worth a doctor's effort to take patients.

You are right. Of course doctors should not make mistakes, no one thinks that. But cutting back on Medicare payments will make it hard for the elderly to find doctors. And none if it is their fault.

[cstanleytech]

14. Ok, we already were discussing this on another thread maybe you can explain it better to me then.

They way I am seeing it right at this moment is this is an attempt to make hospitals try better to prevent things that should never, ever have happened like say a bad blood transfusion.
Now why exactly is it a bad thing for the government to refuse to pay for a bad blood transfusion or to refuse to pay for the hospital to treat the problems the hospital caused with said bad blood transfusion to the patient?
If I go out to eat and order a steak for example I best get a steak or I wont pay for it and they had better fix my order themselves and not expect me to pay for a 2nd meal.

[quidam56]

15. But Hospitals and Doctors NEVER make mistakes !!!

They may give horrifying patient care, but it's called acceptable standards of health care in America. www.wisecountyissues.com

[believe]

16. The way it works

This will be a little technical, but I'll try to keep it simple. What this new Medicare rule means is that a hospital will not be paid any additional money for a small number of complications that happen in the hospital. Every patient visit is documented in a medical record by docs, nurses and other professions. In that record hopefully is what is wrong with the patient when they came in, and what happened to that patient during that stay, includes procedures, complications, labs, radiology etc (I've seen medical records that were six foot thick). That information is read by coders, who go through the medical record and code the data into a computer system using numeric codes (ex hypertension would be 401.9). There are a million rules concerning coding. OK, one new thing the coder now does, is that from that record, decide if each diagnosis coded was present at admission or not. After that these codes are put through a grouper which gives us our DRG (Diagnostic Related Group) this DRG is the basis of what the hospital is paid. Here's an example what could happen, a patient comes into the hospital for pneumonia and during that stay the patient develops a decubitus ulcer. Before 10/1/08 that patient would be paid a DRG with a complication which would give the hospital more money. Now what happens, is the patient is paid just for the pneumonia DRG, the decubitus ulcer is coded but the computer grouper decides it is not to count towards the DRG because it was not present at admission, so the hospital gets less money then it would have previously received. This only affects certain diagnoses and certain DRG's, which is why there will be so little financial impact. On the good side, it will force the hospital to try to eliminate infections, and other complications that they can affect. NO patient will be charged one additional penny after 10/1 then before, that is also part of the law. Just to let you know these Medical records and coding are under constant review by medicare, and coders have to follow the rules laid out by medicare or the hospital can face fines and a return of monies for incorrectly coded records. Sorry if that was a little technical, but I simplified it as much as I could.