Wrong-Site Surgery Won't be Reimbursed By Medicare

Medicare will no longer pay hospitals for additional care associated with 11 types of “hospital-related conditions” as of October 1, 2008.

The no-pay list has been updated from eight to eleven types of medical errors and infections to now include: problems relating to blood clots that form after total hip and knee replacement surgery, issues relating to poor blood sugar control and surgical-site infections that develop after certain types of elective medical procedures like that of spine surgery.

Hospitals are forbidden, by Medicare, to charge patients for this care.

Proponents welcome the new measure saying it will help make hospitals to do more to prevent medical errors and infections that will reduce overall medical costs, while saving patients lives.

But opponents are unsure of Medicare’s approach and say any extra costs absorbed by health care providers will only shift to consumers.

The updated no-pay list, which stems from the Deficit Reduction Act of 2005, is expected to save Medicare an estimated $21 million over the next three fiscal years and $22 million in the two years following. But, that is only a fraction of what Medicare pays out.

The program budgeted $413.3 billion for benefits in 2009, which includes $126.4 billion for inpatient care and $22.6 billion for outpatient hospital care.

“These quality measures are less about savings and more about changing hospitals and making them safer places,” said Kerry Weems, Acting Administrator of Centers for Medicare & Medicaid Services (CMS), in a conference call last month.

On July 31, letters were sent out by CMS announcing its updated no-pay list, encouraging state Medicaid directors to follow along. An estimated 20 states have already begun or are expected to consider eliminating payment for “never events.”

Never events are described as errors in medical care that are clearly preventable and serious in consequence for patients and that indicate serious problems in the safety and credibility of a health care facility. #