AP/Washington Times Examines Effects Of New Rule On Medicare Hospital Reimbursements For Preventable Conditions

Main Category: Medicare / Medicaid / SCHIP
Also Included In: Public Health
Article Date: 20 Feb 2008 - 8:00 PDT

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The AP/Washington Times on Tuesday examined the effects of a new rule under which Medicare no longer will reimburse hospitals for the treatment of certain preventable conditions (Neergaard, AP/Washington Times, 2/19).

Under the rule, which will take effect on Oct. 1, Medicare no longer will reimburse hospitals for the treatment of eight conditions: falls; mediastinitis, an infection that can develop after heart surgery; urinary tract infections that result from improper use of catheters; pressure ulcers; vascular infections that result from improper use of catheters; objects left in the body during surgery; air embolisms; and blood incompatibility. CMS will add three additional conditions to the list next year. The rule also mandates that hospitals "cannot bill the beneficiary for any charges associated with the hospital-acquired complication" (Kaiser Daily Health Policy Report, 8/20/07). CMS estimates that the rule would save Medicare $190 million over five years.

The rule has prompted several private health insurers, such as Aetna, to implement similar policies, and Pennsylvania last month announced that the state Medicaid program will implement a similar regulation. In addition, the rule has the "nation's hospitals exploring innovative programs to prevent injury and infection," the AP/Times reports. The American Hospital Association has asked members to voluntarily stop billing for treatment of serious errors, and hospitals in a number of states, such as Minnesota and Vermont, have agreed to implement such policies, according to the AP/Times (AP/Washington Times, 2/19).

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