Medicare Won’t Pay Hospitals for Errors


WASHINGTON (AP) – It’s a new way to push for patient safety: Don’t pay hospitals when they commit certain errors. Medicare will start hitting hospitals where it hurts in October, and other insurers are hot on the trail.

That has the nation’s hospitals exploring innovative programs to prevent injury and infection: Hand-washing spies. Surgical sponges that sound an alarm if left in the body. Even a room sterilizer that promises to wipe out bacteria left lurking on bedrails.

“Money talks,” says Dr. Steven Gordon, infectious disease chief at the Cleveland Clinic Foundation. “Every hospital CFO, this gets their attention.”

And patients’ first sign that something is changing may involve lessening of a big indignity: Today, one in four hospitalized patients is outfitted with a urinary catheter. The tubes trigger more than half a million urinary tract infections a year, the most common hospital-caused infection.

Yet many patients don’t even need catheters – they’re an automatic precaution after certain surgeries – and many who do have them for days longer than necessary. Why? The University of Michigan reported the first national study of catheter practices last month, finding nearly half of hospitals don’t even keep track of who gets one. Fewer than one in 10 hospitals does a daily check to see if the catheter is still needed, a simple but proven infection-reducing system.

With those infections topping Medicare’s do-not-pay list, Gordon says hospitals already are beginning to get choosier about who needs catheters, and to yank them faster.

Even when a hospital makes a preventable error, it still can be reimbursed for the extra treatment that patient will now require. Some errors can add $10,000 to $100,000 to the cost of a patient’s stay.

Beginning Oct. 1, Medicare no longer will pay those extra-care costs for eight preventable hospital errors, including catheter-caused urinary tract infections, injuries from falls, and leaving objects in the body after surgery. Nor can hospitals bill the injured patient for those extra costs.

Next year, Medicare will add three more errors to the no-pay list; ventilator-caused pneumonia and drug-resistant staph infections are top candidates.

Medicare, which insures about 44 million elderly and disabled people, estimates the move will save the government about $190 million over five years.

It also sparked a movement: Private insurance giants like Aetna are moving to make hospitals absorb the cost of serious errors. Pennsylvania last month said it would follow Medicare’s example and stop Medicaid payments, too. The American Hospital Association is urging members to voluntarily quit billing for treatment of serious errors, and hospitals in a number of states, from Minnesota to Vermont, have announced they will.

Many hospitals already were trying to improve patient safety for a bigger reason – to prevent suffering and death – and a question is whether making them literally pay for mistakes will spur greater improvements. But some novel attempts are under way:

_A standard mop-and-bucket cleaning leaves bacteria in hospital rooms, especially on electronic equipment that janitors hesitate to touch. So the Wellmont Health System in Kingsport, Tenn., is testing a portable machine that sterilizes a closed room by spewing out vaporized hydrogen peroxide that reach into every nook and cranny.

STERIS Corp.’s VaproSure is proven to eliminate tough germs; it has long been used in sterile manufacturing facilities, and even helped clean buildings tainted in the 2001 anthrax attacks.

But doctors, nurses and others bring new germs into rooms every time they enter, raising the question of whether sterilizing between check-ins will really lead to fewer infections.

“There’s no question they can sterilize a room,” Wellmont chief executive Dr. Richard Salluzzo says of the $180,000 machines. “Has it prevented infection? We don’t have the answer to that yet.”

He hopes to have enough data to tell by year’s end.

_Nurses count surgical sponges to make sure they’re all out before a patient is sewn up, but every hospital occasionally misses some. In University of Michigan operating rooms, doctors are testing sponges tagged with bar code-like radiofrequency chips. Wave a wand and a beep sounds if a sponge is still in the wound. Or, nurses can drop used sponges into a “smart” bucket that counts how many are missing.

“We’ve had a long history in medicine of this problem continuing to occur no matter what kind of very careful steps we’ve devised,” says clinical affairs chief Dr. Darrell Campbell, a well-known patient safety specialist. “We want to get to zero.”

_In U-Michigan’s hospital halls, physician assistants are assigned to spy to tell if fellow workers wash hands both when entering and exiting patient rooms. Workers are better at remembering on the way in, but they don’t want to carry germs back to the nurses’ station or elevator buttons, either, Campbell notes. Some bugs can live on cool hospital surfaces for weeks.

There is some concern that the no-pay push could make hospitals try to hide certain errors, or just trade one problem for another. Pull a urinary catheter too soon, for example, and a fragile patient may fall going to the bathroom, says Michigan’s Campbell.

“I don’t know how much is really preventable,” adds the Cleveland Clinic’s Gordon. “We want to chase zero, but we’ll probably never get to zero.”

Lauran Neergaard covers health and medical issues for The Associated Press in Washington

Medicare Won't Pay Hospitals for Errors


WASHINGTON (AP) – It’s a new way to push for patient safety: Don’t pay hospitals when they commit certain errors. Medicare will start hitting hospitals where it hurts in October, and other insurers are hot on the trail.

That has the nation’s hospitals exploring innovative programs to prevent injury and infection: Hand-washing spies. Surgical sponges that sound an alarm if left in the body. Even a room sterilizer that promises to wipe out bacteria left lurking on bedrails.

“Money talks,” says Dr. Steven Gordon, infectious disease chief at the Cleveland Clinic Foundation. “Every hospital CFO, this gets their attention.”

And patients’ first sign that something is changing may involve lessening of a big indignity: Today, one in four hospitalized patients is outfitted with a urinary catheter. The tubes trigger more than half a million urinary tract infections a year, the most common hospital-caused infection.

Yet many patients don’t even need catheters – they’re an automatic precaution after certain surgeries – and many who do have them for days longer than necessary. Why? The University of Michigan reported the first national study of catheter practices last month, finding nearly half of hospitals don’t even keep track of who gets one. Fewer than one in 10 hospitals does a daily check to see if the catheter is still needed, a simple but proven infection-reducing system.

With those infections topping Medicare’s do-not-pay list, Gordon says hospitals already are beginning to get choosier about who needs catheters, and to yank them faster.

Even when a hospital makes a preventable error, it still can be reimbursed for the extra treatment that patient will now require. Some errors can add $10,000 to $100,000 to the cost of a patient’s stay.

Beginning Oct. 1, Medicare no longer will pay those extra-care costs for eight preventable hospital errors, including catheter-caused urinary tract infections, injuries from falls, and leaving objects in the body after surgery. Nor can hospitals bill the injured patient for those extra costs.

Next year, Medicare will add three more errors to the no-pay list; ventilator-caused pneumonia and drug-resistant staph infections are top candidates.

Medicare, which insures about 44 million elderly and disabled people, estimates the move will save the government about $190 million over five years.

It also sparked a movement: Private insurance giants like Aetna are moving to make hospitals absorb the cost of serious errors. Pennsylvania last month said it would follow Medicare’s example and stop Medicaid payments, too. The American Hospital Association is urging members to voluntarily quit billing for treatment of serious errors, and hospitals in a number of states, from Minnesota to Vermont, have announced they will.

Many hospitals already were trying to improve patient safety for a bigger reason – to prevent suffering and death – and a question is whether making them literally pay for mistakes will spur greater improvements. But some novel attempts are under way:

_A standard mop-and-bucket cleaning leaves bacteria in hospital rooms, especially on electronic equipment that janitors hesitate to touch. So the Wellmont Health System in Kingsport, Tenn., is testing a portable machine that sterilizes a closed room by spewing out vaporized hydrogen peroxide that reach into every nook and cranny.

STERIS Corp.’s VaproSure is proven to eliminate tough germs; it has long been used in sterile manufacturing facilities, and even helped clean buildings tainted in the 2001 anthrax attacks.

But doctors, nurses and others bring new germs into rooms every time they enter, raising the question of whether sterilizing between check-ins will really lead to fewer infections.

“There’s no question they can sterilize a room,” Wellmont chief executive Dr. Richard Salluzzo says of the $180,000 machines. “Has it prevented infection? We don’t have the answer to that yet.”

He hopes to have enough data to tell by year’s end.

_Nurses count surgical sponges to make sure they’re all out before a patient is sewn up, but every hospital occasionally misses some. In University of Michigan operating rooms, doctors are testing sponges tagged with bar code-like radiofrequency chips. Wave a wand and a beep sounds if a sponge is still in the wound. Or, nurses can drop used sponges into a “smart” bucket that counts how many are missing.

“We’ve had a long history in medicine of this problem continuing to occur no matter what kind of very careful steps we’ve devised,” says clinical affairs chief Dr. Darrell Campbell, a well-known patient safety specialist. “We want to get to zero.”

_In U-Michigan’s hospital halls, physician assistants are assigned to spy to tell if fellow workers wash hands both when entering and exiting patient rooms. Workers are better at remembering on the way in, but they don’t want to carry germs back to the nurses’ station or elevator buttons, either, Campbell notes. Some bugs can live on cool hospital surfaces for weeks.

There is some concern that the no-pay push could make hospitals try to hide certain errors, or just trade one problem for another. Pull a urinary catheter too soon, for example, and a fragile patient may fall going to the bathroom, says Michigan’s Campbell.

“I don’t know how much is really preventable,” adds the Cleveland Clinic’s Gordon. “We want to chase zero, but we’ll probably never get to zero.”

Lauran Neergaard covers health and medical issues for The Associated Press in Washington

Medicare Says It Won’t Cover Hospital Errors


New York Times: 19/Ago/2007

WASHINGTON, Aug. 18 — In a significant policy change, Bush administration officials say that Medicare will no longer pay the extra costs of treating preventable errors, injuries and infections that occur in hospitals, a move they say could save lives and millions of dollars.
Private insurers are considering similar changes, which they said could multiply the savings and benefits for patients.
Under the new rules, to be published next week, Medicare will not pay hospitals for the costs of treating certain “conditions that could reasonably have been prevented.”
Among the conditions that will be affected are bedsores, or pressure ulcers; injuries caused by falls; and infections resulting from the prolonged use of catheters in blood vessels or the bladder.
In addition, Medicare says it will not pay for the treatment of “serious preventable events” like leaving a sponge or other object in a patient during surgery and providing a patient with incompatible blood or blood products.
“If a patient goes into the hospital with pneumonia, we don’t want them to leave with a broken arm,” said Herb B. Kuhn, acting deputy administrator of the Centers for Medicare and Medicaid Services.
The new policy — one of several federal initiatives to improve care purchased by Medicare, at a cost of more than $400 billion a year — is sending ripples through the health industry.
It also raises the possibility of changes in medical practice as doctors hew more closely to clinical guidelines and hospitals perform more tests to assess the condition of patients at the time of admission.
Hospital executives worry that they will have to absorb the costs of these extra tests because Medicare generally pays a flat amount for each case.
The Centers for Disease Control and Prevention estimates that patients develop 1.7 million infections in hospitals each year, and it says those infections cause or contribute to the death of 99,000 people a year — about 270 a day.
Intravenous catheters are widely used to provide hospital patients with medications, nutrition and fluids, but complications are relatively common.
One state, Michigan, has had spectacular success with systematic efforts to reduce infection rates in intensive care units.
Susan M. Pisano, a spokeswoman for America’s Health Insurance Plans, a trade group, said, “Private insurers will take a close look at what Medicare is doing, with an eye to adopting similar policies.”
Consumer groups welcomed the change. And while hospital executives endorsed the goal of patient safety, they said the policy would require them to collect large amounts of data they did not now have.
Lisa A. McGiffert, a health policy analyst at Consumers Union, hailed the rules.
“Hundreds of thousands of people suffer needlessly from preventable hospital infections and medical errors every year,” Ms. McGiffert said. “Medicare is using its clout to improve care and keep patients safe. It’s forcing hospitals to face this problem in a way they never have before.”
Christine K. Cahill, a registered nurse who used to inspect hospitals for the California Department of Public Health, said: “This is a great start. Infection-control specialists have been screaming for 20 years that federal and state officials should pay more attention to this problem because hospital infections hurt patients and cost money.”
The Bush administration estimates the new policy will save Medicare $20 million a year. But other experts say the savings could be substantially greater.
Nancy E. Foster, a vice president of the American Hospital Association, agreed that doctors and hospitals knew how to prevent the transfusion of incompatible blood products and should not be paid more if they accidentally left objects in patients during surgery.
But Ms. Foster said that some of the conditions cited by Medicare officials were not entirely preventable. Commenting on the proposed rules in June, the American Hospital Association said, “Certain patients, including those at the end of life, may be exceptionally prone to developing pressure ulcers, despite receiving appropriate care.”
In most states, Ms. Foster said, hospital records do not show whether a particular condition developed before or after a patient entered the hospital. Under the new rules, she said, hospitals will have to perform more laboratory tests to determine, for example, if patients have urinary tract infections at the time of admission.
Dr. Tammy S. Lundstrom, the chief medical officer at Providence Hospital in Southfield, Mich., said, “The rules could encourage unnecessary testing by hospitals eager to show that infections were already present at the time of admission and did not develop in the hospital.” Moreover, she said, “Serious, costly infections can occur even when doctors and nurses take all the recommended precautions.”
The rules, first reported in The Star-Ledger of Newark, carry out a directive from Congress included in a 2006 law. When they were proposed in May, consumer advocates said they feared that some hospitals might charge patients for costs that Medicare refused to pay.
But that is forbidden. “The hospital cannot bill the beneficiary for any charges associated with the hospital-acquired complication,” the final rules say.
Eileen O’Neill-Pardo of Everett, Wash., said her experience showed the need for the rules. Her 82-year-old mother, Margaret M. O’Neill, died of an infection that developed during intestinal surgery at a Seattle hospital in 2004.
“The operation — to remove scar tissue — was successful, but the patient died,” Ms. O’Neill-Pardo said. “The hospital staff did not take steps to control the infection, which took over her body. My mother died less than a week after the operation.”
Michigan hospitals have been extremely successful in reducing bloodstream infections related to such catheters, researchers reported recently in The New England Journal of Medicine. The hospitals did not use expensive new technology, but systematically followed well-established infection-control practices, like covering doctors and patients from head to toe with sterile gowns and sheets while the catheters were inserted.
Hospital executives said these techniques had saved 1,700 lives and $246 million by reducing infection rates in intensive care units since 2004.
Some of the complications for which Medicare will not pay, under the new policy, are caused by common strains of staphylococcus bacteria. Other life-threatening staphylococcal infections may be added to the list in the future, Medicare officials said.
Dr. Kenneth W. Kizer, an expert on patient safety who was the top health official at the Department of Veterans Affairs from 1994 to 1999, said: “I applaud the intent of the new Medicare rules, but I worry that hospitals will figure out ways to get around them. The new policy should be part of a larger initiative to require the reporting of health care events that everyone agrees should never happen. Any such effort must include a mechanism to make sure hospitals comply.”