Medicare Says 'No' to Bed Sores and Other Hospital Complications

[Judi Lynn]

Source: Washington Post

Medicare Says 'No' to Bed Sores and Other Hospital Complications
By Cindy Skrzycki
Tuesday, October 21, 2008; Page D02

Hospitals will no longer get paid for some specific treatment errors, including infections, bed sores and objects left inside patients after surgery, under a new Medicare policy.

Regulators at the Centers for Medicare and Medicaid Services told about 3,500 U.S. hospitals that as of Oct. 1, they won't be reimbursed for such so-called "never events" that patients should never acquire during a hospital stay. The dozen treatment areas on the list are considered "reasonably preventable" and aren't present when a patient checks in.

In an Aug. 19 final rule, the government estimated that some $21 million would be saved annually by not paying for 500,000 follow-up procedures to correct complications from the hospital hall of horrors. That's a drop in the catheter compared with the $110 billion in payments Medicare makes to hospitals each year.

Still, officials say the payoff will be in improving the standard of care, focusing hospitals on prevention and saving patients the pain of unnecessary treatment.



Read more: http://www.washingtonpost.com/wp-dyn/content/article/2008/10/20/AR2008102002772.html

[amitten]

1. "A drop in the catheter"? Um...tacky writing. n/t

[Pastiche423]

44. What's tacky about that?

Medicare has already drop reimbersement of catheters.

[napi21]

2. I don't disagree with that, as long as they mandate the hospital to correct

their mistakes at their own expense. If you fuck up, you have to fix it! Why don't I think it's really going to work like that?

[murielm99]

3. People will end up suing to get those expensive errors

paid for by the hospitals. Then insurance will go up. Lawyers will make money. Democrats will be blamed, because of course all those trial lawyers are liberals. This will end up becoming more grist for the republican propaganda mills.

This is just one more reason we need to win this election, and win big.

[AllentownJake]

8. It serves another purpose

Get more networks to not take Medicare and try to destroy the one universal health care coverage we have in this country. W has been at war with Medicare since taking office.

[Ian David]

11. Repukes and Conservatards have been at war with it since its inception. n/t

[AllentownJake]

7. In the defense of hospitals

Medicare is making hospitals pay for any complications the patient has now after admitting an Medicare patient. So what the hospitals are doing is ordering a whole series of unnecessary tests so that they can be sure they can bill Medicare for the complication saying it isn't our fault.

Bed Sores especially among the elderly are common for a Hospital visit. It doesn't mean the hospital was necessarily at fault for lack of proper treatment.

At the end of the day you'll have more hospitals trying to avoid Medicare patients by having less primary care physicians and specialist taking them due to the increased health network expenses which is the Bush Administrations goal to begin with.

[DangerDave921]

36. bed sores

While technically preventable, they are almost impossible to prevent in the real world of a busy hospital. Old people and obese people are the biggest culprits. It's just very hard to find the time and personnel to manually turn people every two hours. And for obese people, one needs 4-5 people to do it every two hours. That is a lot to ask of a hospital when it has hundreds of other patients to care for.

[WatchWhatISay]

4. Bedsores, or pressure wounds, as they are called in the medical field

are the result of a lack of care - but with the patient load that caregivers must work under, they are also inevitable.

[pnwmom]

5. So the costs will just add to the bills of non-Medicare patients. Lovely. n/t

[OPERATIONMINDCRIME]

16. No It Won't. They Aren't Allowed To Bill The Patient.

[whoopingcrone]

6. when medicare won't pay

the hospital for treatment you've been given, the hospital bills you.
so we now will have a situation where:
1. person is hospitalized
2. hospital damages person
3. hospital treats person to repair damage
4. hospital submits bill to medicare
5. medicare refuses to pay
6. hospital bills damaged person for repairing the damage its employees caused.
7. damaged person has to deal with injury to his/her pocketbook as well as his/her body.
What a crock.

[midnight]

9. Very nice analysis. It is just common sense. But it probably

will not be part of the conversation from the Hospital... They only listen to marble floors, expansion, and insurance company's.

[madrchsod]

10. trial lawyers will be busy...

why should my insurance company pay out close to 20 thousand for the infection i received during surgery? the extra cost of their neglect is forcing me into bankruptcy. plus the condition still is`t "fixed"

insurance companies mirror what medicare pays for procedures

[Supersedeas]

12. another excuse for Medicare to pass the bill to the sick and elderly

[OPERATIONMINDCRIME]

19. Learn The Facts. The Hospital Cannot Bill The Patient.

[OPERATIONMINDCRIME]

17. Wrong. The Hospital Cannot Bill The Patient For Those Things.

[NC_Nurse]

13. Lots of times patients come in with bedsores and infections. Some are so

debilitated that it DOES NOT MATTER how much you work to prevent these problems they happen anyway.

All this means is that hospitals will be documenting more carefully on patient admission - and losing money anyway.

Most of the hospitals that treat those without money or insurance will fall into financial crisis. Others will start finding ways to reject patients
with prior issues, or that are Medicare/Medicaid patients. It's a matter of staying solvent.

I don't know what the answer is, certainly there are cases of poor care, but not always.

[ellacott]

20. This is very true

Documentation is the key. I work in coding and we have a new field called, Present on Admission. If we code yes then the hospital can't bill Medicare ot any other insurer. We've been doing this for a couple of years. They have to write it off. It's really a good thing because it improves the quality of care. Many of the complications are preventable.

[w8liftinglady]

23. and the hospital will be finger-pointing instead of adding that extra staff member

[ellacott]

34. No they won't. They can't afford to do that

If they have repeated violations by Medicare they risk getting their priviledges revoked. As much as hospitals gripe about Medicare they wouldn't be able to operate if it weren't for the revenue from Medicare funding.

[backscatter712]

14. As long as the hospitals are forced to pay for their own fuckups, I'm there.

There's no excuse for leaving surgical instruments inside patients, or allowing them to develop bedsores. If a hospital allows this shit to happen, they should foot the bill to treat these patients.

[OPERATIONMINDCRIME]

15. Sounds Quite Fair. They Shouldn't Be On The Hook For It.

[DangerDave921]

18. and some want . . .

the federal government running everyone's healthcare.

[TreasonousBastard]

22. My point exactly.

[DangerDave921]

29. Limited Resources

Versus unlimited treatment. There is the crux of the healthcare debate. Our technology has progressed to the point where we have amazing tools out there to screen/diagnose/treat medical problems. But this is expensive stuff. There has to be -- HAS TO BE -- some limit on what healthcare we can reasonably provide to each person. It's just a simple fact. I'd like to go to Hopkins 4 times a year for physicals and full-body scans and get every test available. But it's not reasonable. How do we balance reasonable care with limited amount of money. Makes for tough choices. And even with single-payer, these choices will need to be made.

[Texasgal]

43. Not this one.

I do not trust the government to wipe my ass much less manage my health.

I'm with you, although it's quite unpopular here on DU.

And just so people know, I am an RN. I work at a huge cataract surgical practice, almost ALL medicare. I've seen medicare pull some horrible injustices on our seniors, enough to know that I am not willing to give in to the universal health concept.

[madfloridian]

21. It means fewer doctors will take Medicare patients. At 65 you go on Medicare automatically

So that will put a hell of a lot of people in bad situations. Fewer doctors take Medicare now, anyway. This will add to the problem.

I know, let's do what the Republicans want...do away with it.

Then young people can provide medical care to their parents who can no longer afford it. And when they do away with Social Security, young people can provide that as well.

It is not the hospital that will suffer with this new Medicare directive...it is the patients themselves.

http://journals.democraticunderground.com/madfloridian/2825

I heard all the excuses when I posted this earlier.

It is not a good move, it will hurt people.

[madfloridian]

24. How many at DU can pay for their parents medical care?

Raise your hands...cause they are systematically destroying it little by little and some of it in big chunks.

They are privatizing it right before our eyes without saying a word about what they are doing.

No Democrats are speaking out...no one is telling seniors to be on guard...that they do NOT have to pick a new program. No one is being honest.

http://journals.democraticunderground.com/madfloridian/2825

[madfloridian]

25. Dupe

[ellacott]

26. They have to control hospital controlled errors

It's higher than you think. Prevention can control a large majority of these cases.

[madfloridian]

30. That is not the real isue here. It is another step to destroying Medicare.

and/or turning it over to private companies that are not regulated.

[ellacott]

32. No that is the real issue

There is a lot of abuse in they system and this is a control that is needed. Medicare is enacting lots of regulations.

[madfloridian]

33. They are enacting it out of existence.

:shrug:

[ellacott]

37. No they aren't. There has been a tremendous amount of fraud committed against Medicare

These regulations have saved/recovered billions of dollars for Medicare.


I work in an hospital and do auditing and compliance for Medicare.

Very few private insurers would want to take medicare cases because of the complexity and higher costs of these patients.

There are major issues regarding Medicare costs but there aren't a lot of commercial insurers who are waiting for Medicare to be privatized.

[madfloridian]

39. The "fraud" accusation is why many doctors are refusing patients.

They are scared to death of being accused of committing fraud, and they are not willing to take the chance.

[ellacott]

40. That's so untrue

You can't be charged with fraud unless you commit fraud or have sloppy records.

I have never heard one doctor say they were getting out because they are afraid of fraud.

Blue Cross and Medicaid have the same standards regarding fraud. They would have to get out of medicine if they were scared of someone accusing them of doing something wrong.

Many doctors get out because the reimbursement is smaller. They don't like the regulations but most commercial payors are adopting Medicare's guidelines for their patients.

[madfloridian]

41. I differ with you....but the problem is doctors are not taking Medicare patients.

That is a problem.

The problem is they are paying less and less, and groups are having to work harder to keep them from cutting more services every year.

It's nice you are happy with it all, but I see too many who are not.

Take bloodwork. Last I heard if a doctor orders a panel of tests...Medicare will only pay if something is wrong. If nothing is wrong the patient pays. My neighbor's last statement said in effect that they would pay for the tests that the doctor ordered that time since the patient may not yet be aware of it. But that after that if the work was normal the patient would have to pay.

That is not okay. Doctors are having their abilities to care for their patients undermined more and more.

But glad you are happy with it.

[ellacott]

42. I'm happy about it?

Where in the world did I say that? Why in the world did you choose to add words to what I said?

I said I worked in the field, I never said anything about being happy about.

If you get bloodwork with no diagnosis and your insurance is Blue Cross you will probably have to pay with them also.

You are singleing out Medicare when all insurance has issues.

You're not even trying to listen. It's more important that you are right.

Do your thing....

[madfloridian]

46. Under regular private insurance...they pay for bloodwork a doctor prescribes.

You seem unaware the goal of the Bush administration is to destroy Medicare. Dismantle it.

Every step they take in restricting payments is another step in that direction.

Seniors are getting mailings making them think they must choose a private plan. Loads of mail to them, enough to confuse a genius, enough to boggle an elderly mind.

They do not have to choose a Medicare HMO...but no one is helping them understand that.

Right? No, I would rather be wrong on this.

[ellacott]

47. They don't pay just because a doctor prescribes it

I don't disagree that Medicare is in trouble but some of facts are simpley wrong and they muddy the conversation.

[jillan]

28. Omg - when I was taking care of my dad during his last year

I could not believe the number of doctors that would not take Medicare - and that was in 2006!
They didn't want to deal with all the extra paperwork and red tape.

[madfloridian]

35. And they are limiting time spent with Medicare patients...

if you have supplemental it helps.

[Pastiche423]

45. Welcome to my world

It took me eight years to get an appt w/a doctor, because NONE were taking Medicare. He only worked there for six months. Now I have no doctor.

[jillan]

27. And in Az, Medicaid just dropped preventive dental care.

They'll be happy to pay for having a tooth pulled, but not for going to the dentist to prevent it.

Yep - let's torture the poor and disabled.

assholes!

[Overseas]

31. Wow, our national priorities are really screwed up.

To save 20 million Medicare is going to reimburse hospitals less for the unfortunate mistakes that do occur.

To save
20,000,000 after we have paid
800,000,000,000 to correct the mistakes of Wall Street.

[hedgehog]

38. Back during the primaries, when everyone was examining the various

proposals to see who would be in and who would be out, would there be fines or no fines, single payer or insurance companies, etc, what impressed me about Obama's plan was his recognition that merely paying for what we have now is only scratching the surface of the problem. He wants to reform the entire health care system to make it serve us better.