Memo to Hospitals: Bad Care Will Cost You
You're unlikely to be surprised to hear that hospitals are routinely paid for indifferent or bad care, but did you know that it is implicitly built into the Medicare system? Say a Medicare patient is admitted for surgery, develops an infection because of sloppy post-surgical care, and has to stay several days longer than expected. The hospital will be reimbursed for at least some of the expenses due to its own failings.
This is because the infection is considered a complication under current Medicare rules, and hospitals are paid for treating complications. One way is for the complication to be recoded into a higher-reimbursement category. The other is that hospitals get back 80 percent of the amount above a threshold that changes every year (it's $24,485 for 2007). So if the infection generates extra costs of $75,000 (which isn't difficult these days), the hospital eats the first $24,485 but gets back 80 percent of the remaining $50,515, or more than $40,000. That's how it's been for decades. Is that crazy or what?
I'm happy to say that because of a new rule issued earlier this month by the Centers for Medicare and Medicaid Services, which reimburses hospitals, this is one gaping loophole that won't stay open too much longer. This October, hospitals will have to start checking Medicare patients for certain conditions when they're admitted, and in October 2008, CMS won't pay for the cost of treating those conditions—bedsores, to take one example—unless patients come into the hospital with them.
Nor will the feds pay extra if a sponge or other object has to be retrieved from a patient's insides, where it was left accidentally (this is called a "never event" by the quality gurus because it should never happen), or for injuries stemming from a fall (CMS got 2,591 reports of patients falling out of bed in 2006), or a surgical infection, or several other indications of substandard care. And hospitals won't be allowed to pass along the costs of uncompensated care to patients.
All of this makes perfect sense. Why did it take so long?
Tags: hospitals | Medicare | medical errors | rankings
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Reader Comments
Treat or Not
So, does that mean if Medicare won't pay, the hospital won't treat properly or agressively, and the patient dies? Just what is the hospital's responsibility in these hospital-aquired conditions? How is this going to make things better for the patient? In my time, I have seen some awful things happen in hospitals.
who will it cost?
If Medicare will no longer pay to rectify errors made by a hospital, who will? Will the financial as well ss the physical burden and suffering be passed on to the patient and his family? Americans are already sorely overburdened. This measure will only add to the misery of the middle class in America. SHAME on you Mr.Comarow!
Good for CMS
I am a nurse and was recently forced to quit my job, I chose patient safety over patient privacy, I have no problem with patient privacy but the safety of my patient came first without any consideration. I have seen a lot of unnessessary situations arise in my hospital and have felt on numerous occassions that extra things were being done soley for extra money. I have seen Physicians come to the floor or even call a nurse on the phone but never see a patient and ironically a progress note for a visit show up in the chart the next day. Who pays for that? If the rule states that Medicare will not pay for conditions that arise from neglect and or substandard care than I say KUDOS, Nurses and Doctors will start to have to take more responsibility and do things the right way. We do have to make sure the cost is not handed down to the patient, it has to be something that comes out of the pockets of the money makers.
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U.S. News's Avery Comarow has been editor of the America's Best Hospitals annual rankings since their debut in 1990. In his reporting on all aspects of clinical medicine from the latest cholesterol guidelines to robotic surgery, he has kept one question in the front of his mind: What does this mean to patients? That perspective uniquely qualifies him to observe and comment on the efforts by hospitals and other healthcare providers to improve care and patient safety.
