The numbers of patients who become sicker because they checked into a hospital is staggering--some say the number is 200,000 cases a year. Sometimes, the problem is an error, like treating the wrong body part or leaving behind an object following surgery. More frequently, though, the cause is Hospital-Acquired Infections, such as MRSA, which is more and more drug-resistant.
Recently, the Medicare/Medicaid system (CMS) announced that it would no longer pay the bill for certain conditions that are caused by medical errors. It is expected that there will be a 'trickle down' effect on medical plans. By refusing to subsidize sloppy work, CMS is hoping to force hospitals to re-examine their procedures to cut down on errors. Among the errors CMS will no longer reimburse, beginning with discharges October 1, 2008:
- Objects left in the body after surgery;
- Death or serious disability resulting from an intravascular air embolism;
- Death or injury resulting from blood incompatibility.
These three situations are considered serious preventable events by CMS, ones that should never occur. Other problems that occur with disturbing frequency, for which payment will be denied if the conditions are not present when the patient is admitted to the hospital, include:
- Urinary tract infections associated with catheter use;
- Pressure ulcers (bedsores);
- Infections associated with vascular catheters;
- A particular type of surgical site infection; and
- Hospital acquired injuries, like fractures, burns, or dislocations that are caused by the hospital.
It is likely that this list will grow in coming years. In the meantime, HR professionals should discuss the situation with their health plan representatives, to find out whether the plan is taking a stand similar to that of CMS. The State of Massachusetts and their largest private health insurer, Blue Cross and Blue Shield of Massachusetts, for example, recently decided that they too will no longer pay for certain medical errors. They have identified 28 types of errors involving medications, surgery and other medical procedures for which they will no longer pay. This decision will impact roughly 4 million people in the state, and is expected to increase pressure on hospitals to improve their quality of care.
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