Medicare Won't Pay For Errors
Pay for Performance Updates to Medicare Reimbursement System
Hospitals have been on notice for some time now that costly errors would no longer be covered. Pay for Performance began several years ago and is getting stricter now.
Effective October, 2008, Medicare will no longer pay for preventable hospital mistakes as updates to the Pay for Performance plan take place. Each year over 100,000 Americans die from mistakes made in hospitals and Medicare is taking the lead to create a proactive status of paying for quality health care.
In 2005, Congress passed this law which takes effect next year. Consumer groups and government officials hope that this will provide hospitals with the incentive to establish and enforce guidelines to improve the quality of care provided in their facilities. In the future the hospital will have to foot the bill for any treatment needed to correct mistakes which are deemed largely preventable.
Included in the conditions that will be deemed preventable mistakes are:
- nosocomial infections (infections patients catch in the hospital due to poor infection control processes)
- surgeries necessary to retrieve objects such as sponges or instruments left behind
- treatment due to being given the wrong blood in a transfusion
- bedsores that develop during hospitalization
- injuries from a fall sustained in the hospital
Nosocomial infections which will no longer be covered by Medicare are most commonly associated with urinary (Foley) catheters, IV lines and coronary bypass surgery.
Stringent handwashing and other infection control protocols have long been in place in most facilities, but they aren't always adhered to. Now monetary incentives will encourage facilities to enforce these rules. The shortage of nurses contributes to this problem and will continue to create a separate set of issues in the efforts to improve the situation.
Studies have shown that getting patients off of IV therapy and removing Foley catheters as soon as possible help to reduce injury and infections from their use.
Patient safety and quality of care standards have long been the focus of accrediting agencies such as JCAHO, the Joint Commission on Accreditation of Healthcare Organizations. Hospitals and other health care facilities have had to establish and prove accountability and adherence to JCAHO's standards to become and remain accredited.
CMS (the Centers for Medicare and Medicaid Services) initiated a program of reporting quality of care issues and how individual hospitals rank a few years ago. This has provided impetus to hospitals to improve their quality of patient care and safety. Now hospitals will have financial incentives to enforce and live up to those standards at all time, not just when being surveyed.
Medicare insures Americans age 65 and over and the permanently disabled in the U.S. It is expected that private insurance companies will follow suit in withholding payment for hospital errors. Consumer groups have expressed some concern that patients need to be protected so that they are ensured to receive the care needed should the hospital fail to protect them from these mistakes.
CMS hopes that this change in philosophy will encourage hospitals and other health care providers to provide improved quality of care.
Source: New York Times, August 19, 2007
