Medicare To Withhold Payments To Hospitals For Failing To Keep Patients Safe

Our lawyers frequently review cases involving hospital acquired infections, many of which are fatal. New Medicare regulations have been enacted in an effort to prevent these all too frequent tragedies. Under new Medicare regulations, which will become effective in October 2008, hospitals will no longer receive higher payments for the additional costs associated with treating patients for certain hospital-acquired infections and medical errors. The new rules will give hospitals a powerful new incentive to improve patient care, according to Consumers Union, the nonprofit publisher of Consumer Reports. These new regulations are a giant step in the effort to save lives and money by holding hospitals responsible for their preventable negilgent acts which harm patients and cost taxpayers huge sums of money.
“Every year, millions of Americans suffer needlessly from preventable hospital infections and medical errors,” said Lisa McGiffert, Director of Consumers Union’s Stop Hospital Infection’s campaign. “These new rules are a good beginning for Medicare to use its clout to mobilize hospitals to improve care and keep patients safe.”
Under the rules payments will be withheld from hospitals for care associated with treating certain catheter-associated urinary tract infections, vascular catheter-associated infections, mediastinitis after coronary artery bypass graft (CABG) surgery, and five other preventable medical errors. These errors are bed sores, objects left in patients’ bodies, blood incompatibility, air embolism, and falls.
The new Medicare regulations specifically include protections which will prevent hospitals from billing patients when payments are withheld and to minimize avoidance of patients perceived to be at risk for infections.
Catheter-associated urinary tract infections are the most common infection developed by patients in hospitals. The Centers for Disease Control and Prevention (CDC) has reported that there are 561,667 catheter-associated urinary tract infections per year. According to a study in the American Journal of Medicine, the annual cost of urinary tract infections in hospitals is as much as $451 million.
Bloodstream infections are high in volume and cost, and are preventable. The CDC has reported that there are 248,678 cases of central line associated bloodstream infections every year. The Institute for Healthcare Improvement estimates that approximately 14,000 people die every year from central line-related bloodstream infections.
CMS failed to address the incidence of infections caused by methicillin-resistant Staphylococcus aureus (MRSA), a virulent antibiotic resistant bacterium. According to CMS, over 95,000 Medicare patients had MRSA infections in 2005, running up hospital charges of almost $3 billion. MRSA was not selected for nonpayment because of coding issues and because CMS does “not believe there is a consensus among public health experts that MRSA [infection] is preventable.”
Hospital acquired infections are a leading cause of death in the United States. The Centers for Disease Control and Prevention (CDC) estimates that 2 million patients suffer from hospital infections every year and nearly 100,000 of them die. Research shows that hospitals could prevent many infections through stricter adherence to proven infection control practices.
The Centers For Disease Control has estimated that hospital acquired infections result in up to $27.5 billion in additional health care expenses annually. Medicare foots the bill for a big portion of infection-related health care costs.