Medicare Adds Two New Categories Of Preventable Hospital Errors To Do-Not-Pay List

Main Category: Medicare / Medicaid / SCHIP
Article Date: 04 Aug 2008 - 8:00 PST

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CMS on Thursday announced new Medicare reimbursement rules that include additions to a list of preventable conditions for which the program will no longer pay hospitals to treat as of Oct. 1, CQ HealthBeat reports (Reichard, CQ HealthBeat, 7/31).

In August 2007, CMS announced that Medicare no longer will reimburse hospitals for the treatment of certain "conditions that could reasonably have been prevented," and that the facilities "cannot bill the beneficiary for any charges associated with the hospital-acquired complication." The conditions include: falls; mediastinitis, an infection that can develop after heart surgery; urinary tract infections that result from improper use of catheters; pressure ulcers; and vascular infections that result from improper use of catheters. In addition, the conditions include three "never events": objects left in the body during surgery, air embolisms and blood incompatibility (Kaiser Daily Health Policy Report, 4/15).

The new rules will add to the list two conditions: blood clots in the leg after knee- or hip-replacement surgery and complications related to inadequate control of blood sugar levels. In addition, the rules will expand a condition previously on the list to include infections that develop on surgical sites after elective procedures.

According to the AP/San Francisco Chronicle, CMS earlier this year had proposed to add seven other conditions to the list but "backed off" amid concerns raised by hospitals. James Rohack, president-elect of the American Medical Association, said the new rules would reduce the quality of patient care. "We are working hard to improve quality and efficiency, but simply not paying for complications or conditions that, while regrettable, are not entirely preventable is not the way to do it," he said (Freking, AP/San Francisco Chronicle, 7/31).

Acting CMS Administrator Kerry Weems said that the agency has sent a letter to state officials to ask them to consider similar rules in their Medicaid programs. According to CMS, almost 20 states have begun to consider such rules (CQ HealthBeat, 7/31).

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