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Unfortunately I believe that we are limited in what we can focus on. I think that if we proceed with the partisan sideshow of prosecuting Bush admin. officials, healthcare will get lost in the brouhaha.
— Posted by denamom, Obama's Quandary...

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Medicare to Slash Payments for Medical Errors

POSTED: 07:07 AM ET, 10/ 1/2008 by The Editors

The Medicare system has long been under fire for its failure to enforce better quality in the hospitals it reimburses for care. Now federal officials have launched two new programs aimed at addressing this problem, The Post's Gilbert M. Gaul reports.

Starting today, Medicare will slash hospital payments for medical mistakes resulting in patient harm and higher costs to the sprawling federal health plan for the elderly and disabled. Examples of such mistakes include transfusing patients with the wrong blood type and leaving a sponge in a patient during surgery.

And in another development, federal officials late last week approved a new company to begin inspections as part of its often criticized hospital accreditation program. DNV Heathcare becomes the first new accreditor in more than three decades, according to the Houston-based company. Until now, the Joint Commission on the Accreditation of Healthcare Organizations has effectively held a monoply on the hospital reviews, which are required in order to participate in Medicare.

Both moves come as Medicare and growing numbers of private insurers are increasing their focus on patient safety and quality following disclosures of negligent care by advocacy groups, congressional investigators and media outlets.

In July of 2005, Gaul revealed widespread shortcomings in Medicare's quality and oversight programs in a three-part series, Chronic Condition. Among the findings: that the Joint Commission had collected hundreds of millions in fees from its accreditation program while rarely flunking hospitals for poor care and missing glaring cases in which patients were injured or killed. The stories also detailed how hospitals could get higher Medicare payments for mistakes and bad care requiring frequent surgeries and readmissions.

The Deficit Reduction Act of 2005 requires Medicare-participating hospitals to begin reporting a series of clearly preventable medical errors ranging from pressure sores to catheter infections to fractures caused by hospital workers, among other conditions. It has been estimated that Medicare pays for more than half of all hospital-acquired infections.

The Centers for Medicare & Medicaid Services will no longer pay the hospitals an increased rate for the added care resulting from their errors. Medicare will also prohibit billing the additional costs to patients, according to the Center for Medicare Advocacy, a nonprofit group that tracks Medicare developments and advocates for patients.

DNV Healthcare, meanwhile, said it will immediately beging competing with the Joint Commission for hospital accreditations. "We're ready to go," DNV's President, Yehuda Dror said in an interview. "The significance is that for the first time in 40 years a new program has been deemed [approved] by Medicare and hospitals will have a choice." Dror added, "Our role is to be a leader in hospital accreditation, not just to offer another option."

By The Editors |  October 1, 2008; 7:07 AM ET Post Investigations
Previous: Ex-Confidant Testifies Against Stevens | Next: Federal Bailout, Satellite Spy Program, AIG's Influence


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As you see the financial markets imploding, the health care system is on just as thin ice. The reason, hospitals have the problems in the first place is because the system is broken.
Hospitals shorten staffing ratio's to squeeze more out of the money they get. Mortality risk goes up 7% with each additional patient a nurse is given.
Medicare is the standard which private insurer's follow. They use Medicare standards as an excuse to deny payment. This give them more cover not to pay
Sponges, ulcers, falls and blood errors are , preventable, and plain stupid. Hospitals deserve not to be payed for these errors.
Because the nature of hospitals and disease processes some hospital born infections are not.
Many persons who are severely immuno compromised will get infections inside a hospital no matter what you do. You can not place them in an absolutely sterile enviroment. As soon as they are moved into the hall to go to a procedure, they are at risk. The air we breath is not sterile. Hospital air is full of super bugs. As soon as you place a catheter into a person, you place them at risk for an infection. Even when done with the strictest of technique.
Hospitals that take care of relatively healthy populations, in wealthier areas will be least affected.
Hospitals caring for poor, older and thus more compromised persons who are sicker and thus more compromised will get even less reinbursement. These are the "Bear Stearns" providers.
It is vicious cycle. Just deny payment and let market forces do their thing. More shortsighted ignorant right wing mentality. Rather than point fingers, institutions with abnormally high rates of infection should be given more assistance to deal with problems. We can spend a trillion dollars on a useless war, another trillion dollars on bailing out rich stupid people, but "God forbid" we are spending too much money on health care. We are. The rest of the G 7 has universal health care, we are the only first world country that does not. We spend more and have the worst outcomes. The system is broken.
To Just tighten reinbursement is putting lipstick on a pig.
We already have dumping in Hawaii. Thats when a hospital gives the poorly reinbursed patients to another institution. We have one hospital crippled by it. 150 layoffs yesterday. A domino effect is in place. Now the other institutions, will get those money losers, and be bled dry and fail. This rule change has just provided another class of money losing patients to dump.

Posted by: Russ | October 1, 2008 1:27 PM

Medicare and Medicaid are already slashing payments to "greedy" hospitals and doctors. In addition, the bank insolvency crisis has made it difficult for hospitals to borrow money in the credit markets which have seized up. As a result, hospitals are also becoming insolvent and are forcing doctors and nurses to cover much larger patient bases as Russ has pointed out. The next unfortunate step is for more hospitals to close and for hospitals that do survive to downsource healthcare to para-professionals who follow simple health care scripts (sounds familiar?) It is time for Americans to accept Universal Healthcare with transparent rationing instead of the covert rationing occurring today through the foul interplay of Byzantine entitlement programs, private insurance, and lawsuit threats. This probably will not happen, instead, some medical practices will simply not accept any payment from public entitlements or from private insurers. Patients who can't afford this will receive their care from understaffed hospitals which will get "bad" reviews, get less funding, and the downward cycle will continue further.

Posted by: Rubik's Cube | October 4, 2008 6:32 PM

I believe that many people have difficulty understanding what injuries are the result of hospital negligence and what are accidental. I don't think that the government is on witch hunt. I have been inside a substandard hospital and I understand what this is about. When hospitals give patients the wrong medicine, leave patients laying in their waste for long periods of time, fail to carry out doctors orders, don't turn patients according to accepted standards, fail to keep facilities clean and so on, that is negligence. The under-staffing that leads to these problems is avoidable.

Some have very bad doctors working in their emergency rooms. These incompetent physicians make too many mistakes that are avoidable. Some have spread staff infections. Some fail to identify life threatening illnesses.

Clearly, there can be complications with any injury and any medical procedure. But, there are standards that can be used to determine if a problem was unavoidable or just carelessness by the hospital. The government isn't going to pay to care for avoidable complications and injuries. I think that insurance companies will follow the same route. Hospitals will find it difficult to bill patients for mistakes without exposing themselves to lawsuits. So, they will have to clean up their acts or eat the cost.

Posted by: Robert M. | October 4, 2008 11:03 PM

it sure is time people start taking care of themselves and stop acting like the government is your parents and take some personal responsability
where in the constitution does it read that the federal government owes you anything but the ability to be free and safe in the world . if you dont have health insurance do like i do and go to the state hospitals and you will see why socialized medicine dont work at any level .

Posted by: chuck | October 5, 2008 1:24 AM


Chrome can't format this....

Posted by: Laff | October 5, 2008 3:35 AM

"House" isn't gonna like this.

Posted by: blanton | October 5, 2008 5:26 AM

I've done QA work for years in hospitals. I am admittedly, extremely anal retentive about health standard compliance and have repeatedly been hired on by hospital groups to address medication compliance standards and help reduce errors. Frankly, I am not surprised at all that another entity has been given accreditation rights because JCAHO is a complete failure to me. I have worked at 2 hospitals groups in FL alone that should have been shut down for severe negligence. Instead they remained open and functioning...all the while the patients in those facilities were exposed to hazardous practices and extreme shortcomings in compliance standards by the nursing, doctor, respiratory and pharmacy departments. Wow, the government did something good to protect tax payer money. I am shocked! Pelosi still needs to lose her title and congressional appointment.

Posted by: JPaul Lear | October 5, 2008 4:49 PM

Mistakes happen. Healthcare workers are human beings, and are prone to error. The only people who will suffer from removing funding for treating iatrogenic injury are patients. Higher-risk patients and difficult procedures will be refused, for risk of having to absorb the costs of mistakes. Overall patient care will suffer as hospitals will have to stretch their budgets further, and patients who have already been failed by the medical system will recieve only the bare minimum level of care possible to avoid litigation. This decision conjures up images of the failed NCLB act that was applied to the education system.

Posted by: Greg G | October 5, 2008 5:25 PM

To some people it seems so cut and dry to not pay a hospital/doctor for a complication. Infortunately it is much more complex. Medicare has adopted what is essentially a "zero defect" policy that states that there isn't any reason any complication should ever occur...the problem is that complications will always occur and CMMS sees this as a way to deny payments. They like to say that they aren't going to pay for errant blood transfusions or sponges left in after surgery, but what they don't tell you is the other 9 things they won't reimburse for such as: catheter infections(unavoidable), DVT's(unavoidable), surgical infection(unavoidable), sedative induced delirium(unavoidable), and the list of unavoidables goes on and on. But what if you are the Anesthesiologist that has to take a patient to the OR to take out the sponge when you weren't involved in the original surgery that left it it wrong to be reimbursed? The end-result is people will begin to get substandard care because doctors will be gun-shy to do anything that might create a complication or they will stop accepting Medicare patients altogether(who amongst us wants to be paid cents on the dollar for anything?). People should stop criticizing "greedy" doctors and starting taking an active approach to keeping themselves healthy because when everything is said and done, it is doctors who must take a patient to the OR who is a medical trainwreck to begin with and do the best that we can with the hand we are dealt.

Posted by: Marc | October 5, 2008 8:57 PM

I have been an RN for 35+ years and know that care could improve in some cases. There are MANY adverse incidences that are "patient induced". No matter how perfect the care, infections will occur. It will BE VERY interesting to see how infections caused by "normal flora" will be separated out. I can forsee patients not being accepted (unless they are young, infection free, and able to pay). The high risk patients will not be welcome. SAD! Hospitals cannot keep picking up the slack either. Objective assessment of adverse events will not always be possible. Some are more clear cut than others. POOR PATIENTS will get caught up in this fight.
Vivian in NC

Posted by: Anonymous | October 6, 2008 4:10 PM

I don't understand how rewarding failure creates incentive to supply a better product. This reasoning to me is completely paradoxical. We tried this with DC public schools, saturating them with money. The results were misuse of the funds, waste and lack of any noticable quality increase.

While cutting funding will be immediatly deletarious we have to remember that rewarding poor performers or those unable to produce results will re-direct the funds to better entities. The future outcome will make us all better. We cannot keep doing something bad because stopping it will cause temporary problems.

Posted by: Rafe | October 7, 2008 10:23 PM

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