In a move intended to cut Medicare costs, improve billing accuracy, and prompt hospitals to improve the quality of patient care, payments for "secondary" diagnoses will end in October 2008. The new rule will cover eight hospital-caused conditions.
"Those conditions are: objects left in a patient during surgery; blood incompatibility; air embolism; falls; mediastinitis, which is an infection after heart surgery; urinary tract infections from using catheters; pressure ulcers, or bed sores; and vascular infections from using catheters." Three more will probably be added next year.
Jeff Nelligan, a spokesman for the federal Centers for Medicare and Medicaid Services, said that the rule "underscores our drive toward quality, efficiency and integrity in the hospital setting."
Hospitals will be expected to bear the costs of treating the conditions on the list, and will not be permitted to bill patients for them.
Medicare provides coverage of medical costs for 43 million disabled and elderly patients, at a cost, in 2006, of about $408 billion. With costs constantly rising, finding ways to cut back on unnecessary payments is a high priority.
On the face of it, the new rule seems to be a step that will motivate hospitals to guard against preventable problems like blood mismatches or air embolisms, and improve patient care overall. But giving it more thought, I began to wonder. Medicare payment to hospitals will be based solely on conditions present at the time of admission. Will it be possible to falsify admission diagnoses so that the hospital will be paid for some conditions that it caused?
More likely, I think, is cases in which the hospital finds a way to deny that a secondary problem was hospital-caused, and thus deny treatment unless the patient can pay for it. Infections that aren't diagnosed until the patient is released seem to be the best candidate, since many of the listed conditions are too obvious. When denial isn't possible, such simple techniques as delays in treatment, or sub-standard treatment are realistic possibilities. Given that most hospitals are for-profit institutions that keep well-paid lawyers on staff, it isn't entirely paranoid to expect the new rule to be bypassed or subverted in one way or another, possibly to the detriment of those least able to defend themselves.
Medicare to Stop Paying for Hospitals' Mistakes
Email
Print
Share
del.icio.us
facebook
newsvine
reddit
stumbleupon
technorati