Medicare Will No Longer Pay For Hospital Mistakes

A recent rule change by Medicare means that the government will no longer pay the bill for hospital accidents that could have been prevented, such as leaving an object in a surgical patient.  This change is designed to improve the accuracy of Medicare’s payments and improve the quality of hospital care for patients.  Private insurance companies are already preparing to follow suit.

There are eight specific conditions itemized in the rule:

• Blood incompatibility
• Air embolism
• Falls
• Mediastinitis (an infection after heart surgery)
• Urinary tract infections from using catheters
• Vascular infections from using catheters
• Pressure ulcers (bed sores)
• Objects left in a patient during surgery

Hospitals must begin reporting these conditions on October 1st of this year, then starting on October 1, 2008, they must absorb the cost of the treatment required to address these preventable situations.  At least three more conditions will be added to the list next year. 

Most experts agree that while these problems are usually not an intentional act to increase the hospital bill, estimated taxpayer savings will easily be hundreds of millions of dollars within the $408 billion Medicare program. 

The implications of this are huge for health insurance providers as well.  Every dollar paid out to cover hospital mistakes affects our health insurance premiums, whether we have individual health insurance or are part of a group health plan.  Now that the hospitals must pay for their mistakes, hopefully patient care will improve as well.  Ultimately this may be a first critical step toward reigning in the cost of healthcare.