Medicare Policy To Withhold Payments To Hospitals That Harm Patients Goes Into Effect

Main Category: Medicare / Medicaid / SCHIP
Article Date: 01 Oct 2008 - 0:00 PST

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New federal regulations to restrict Medicare payments to hospitals for the extra care required to treat patients harmed by certain preventable infections and medical errors go into effect on Wednesday, October 1. The rules adopted by the Centers for Medicare and Medicaid Services (CMS) aims to provide hospitals with a financial incentive to improve patient care.

"Medicare's new policy sends a powerful message to hospitals that harming patients will harm their bottom line," said Lisa McGiffert, Director of Consumers Union's Stop Hospital Infection's campaign (http://www.StopHospitalInfections.org). "This policy will help prevent needless suffering and deaths and ultimately ensure that the health care taxpayers pay for is safe and effective."

Under the new regulations, CMS will withhold payments to hospitals for care needed after patients suffer from certain hospital acquired urinary tract infections; certain bloodstream infections and select surgical site infections - specifically from coronary artery bypass graft (CABG), certain weight loss surgery, laparoscopic gastric restrictive surgery and gastroeneterostomoy, and orthopedic procedures (spine, neck, shoulder, elbow). Other hospital acquired conditions to be covered include serious bed sores, objects left in patients' bodies following surgery; blood incompatibility; air embolism; deep vein thrombosis/pulmonary embolism (formation/movement of a blood clot) following total knee and hip replacement; falls and trauma (such as burns and electric shock); and extreme blood sugar derangement.

The new Medicare regulations include protections to prevent hospitals from billing patients when payments are withheld and to minimize avoidance of patients perceived to be at risk for infections.

"The CMS rules clearly state that hospitals cannot bill patients for the amount that Medicare refuses to pay," said McGiffert. "The federal government needs to make sure these protections are enforced so patients are treated fairly. And Medicare should be on the lookout for hospitals that try to game the system by falsifying codes to avoid nonpayment."

Consumers Union has urged CMS to clarify how it intends to monitor implementation of the news rules and respond to patients who are unfairly billed in these situations. The group has called on CMS to develop an expedited review process for claims from patients who have been harmed by their medical care.

Consumers Union
http://www.StopHospitalInfections.org