An article by Newhouse News Service describes new Medicare and Medicaid regulations that will stop payment to hospitals for treating infections that occur as complications of medical procedures. Or as the Center for Medicare and Medicaid (CMS) call them hospital mistakes. Supposedly the withholding of payment will make the hospitals clean up their procedures and keep these infections from happening in the first place. Some of the practices that contribute to the infections are due to cost cutting measures already in place. So for those hospitals where profit trumps care it will be cheaper to under treat those people that do develop infections with the result that the morbidity and mortality will increase for Medicare and Medicaid recipients. Of course the private health insurance industry has expressed interest in following suit.
Some of these hospital acquired infections are caused by leaving urinary catheters and intravenous lines in too long. The cost of the supplies for these procedures is one reason they are left in too long before changing them. So the carrot and stick rationale is if hospitals don't spend more money to prevent the small per cent of patients that do get infections caused by these practices, they will not be paid to treat these sometimes life threatening infections. In a profit-loss driven health care system it is far more likely that the additional money will not be spent on all the additional catheters and IV lines but instead the cost cutting will be on how aggressively the infections are treated. CMS may not pay if they (bureaucrats) decide that the catheters an IV lines were left in too long. This would be yet another intrusion into Doctor-Patient relations. Additionally, some of these infections are simply the result of frail and susceptible individuals not being able to fight off the bacterial invaders when stressed by the illness that brought them into the hospital in the first place.
"I hope this makes a huge difference,'' said David Knowlton, chairman of the New Jersey Health Care Quality Institute, a nonprofit organization to improve patient safety....Knowlton said Medicare officials must be reasonable, so that victims of medical mistakes are not left without coverage to treat their infections or botched surgery. Meanwhile, McGiffert, of Consumers Union, said CMS will "be on the lookout'' for hospitals that game the system by falsifying codes to increase Medicare payments.
Other incidents that will not be reimbursed are treatments due to:
In addition to hospital infections, the changes mean no extra payments to treat patients affected by:
• Injuries resulting from a fall in the hospital.
• Reactions when transfusion patients get the wrong blood type.
• Air embolism, when air invades the blood stream.
• Bed sores that patients develop while in the hospital.
• Objects, such as sponges or surgical tools, left in patients during surgery.
Already one private health insurance plan will not pay for medical "mistakes" and now:
Mohit Ghose, a vice president of America's Health Insurance Plans, a trade organization based in Washington, said private insurers are looking carefully at the Medicare changes.
"This is one of the areas our members have to look at to advance the cause of improved patient safety and to create better value,'' he said. "But it won't happen overnight.''
It looks like the cost of Medicare and Medicaid programs are being cut on the backs of the health of the most vulnerable once again.