Outside editorial: Rule ends a terrible Medicare practice

Posted: Monday, August 27, 2007

Nobody wants the wrong leg amputated. Such an event is known to hospitals as a "never event": a preventable event that should never, ever happen in medicine. But under current Medicare policy, if a surgeon operates on the left leg when it should have been the right, Medicare is still supposed to pay for the operation. A good new rule announced this month by the Centers for Medicare and Medicaid Services would stop that payment.

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Medicare generally pays a flat fee for patients admitted to hospitals, but it pays a higher amount for patients with additional complications. Beginning in October 2008, eight conditions the medical community views as wholly "preventable" - including bedsores, infections caused by unchanged catheters and leaving an object behind in the patient after surgery - will no longer qualify for higher payment. Instead, hospitals would have to cover the cost of complications brought on by their own errors and would be barred from passing on those costs to patients.

The move is designed to motivate hospitals to pay more attention to patient safety. The Centers for Disease Control and Prevention estimates that each year 1.7 million infections are acquired in hospitals and that 99,000 patients die as a result of these complications. If hospitals were on the financial hook for such problems, the logic goes, they might work harder to adhere to medical guidelines established to prevent those problems.

Hospitals argue that the new rule will trigger more testing upon a patient's admission (to prove that a condition predates the hospital's care), with costs that hospitals themselves will have to absorb. Government regulators see this not as a drawback but as better patient care, and they say that doing relevant testing upfront could save hospitals money in the long run. The administration estimates that the new Medicare rule will save taxpayers about $20 million annually. Given the cost reductions, and the likely boon to patient safety, private insurers are expected to follow suit. HealthPartners, a major insurer in Minnesota, established similar rules against paying for "never events" in 2004.

More still can be done to increase patient safety. State medical error reporting systems have proven to be extremely helpful in determining root causes of errors and developing new patient safety strategies. But many states do not require hospitals to report medical errors. In 2005, Congress passed a law creating a voluntary national patient safety network for reporting and analyzing medical errors, but the regulations for the project have not yet been decided.

Medicare has taken the lead in holding hospitals more accountable for their errors. We hope that other mechanisms will be developed to ensure the elimination of preventable tragedies.

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