Medicare Announces Policy Change

11/17/2008 | Nursing Home Neglect

According to an article today in the Washington PostMedicare announced a policy change this year that could have some serious implications in the area of medical malpractice and nursing home negligence. In short, Medicare will no longer pay for treatment of conditions that were caused by a healthcare provider, or could have been prevented.  The rule identifies eight conditions _ including three serious types of preventable incidents sometimes called "never events" _ that Medicare no longer will pay for.  Those conditions are: objects left in a patient during surgery; blood incompatibility; air embolism; falls; mediastinitis, which is an infection after heart surgery; urinary tract infections from using catheters; pressure ulcers, or bed sores; and vascular infections from using catheters.

Lisa A. McGiffert, a health policy analyst at Consumers Union, 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."

While I can certainly understand the reasons behind this policy change, it does cause me some concern.  If Medicare is no longer going to pay for the costs of treating a medical mistake, who will shoulder this burden?  Will it be passed on to the victim.

Pressure sores, while entirely preventable, are a common occurence in poorly run nursing homes and require extensive treatment.  If the nursing home or hospital is not paid by Medicare to treat the wound, will they do it?

Hans Poppe

Louisville, Kentucky

Update:  I was so concerned about the implications of the new "no pay" rule and whether consumers would be required to foot the bill for the medical mistakes of a hospital, I decided to do some more research.  At least according to Jeff Nelligan, the director of Media Affairs for Medicare, as reported to Fox News, "The hospital cannot bill the beneficiary for any charges associated with the hospital-acquired complication," the final rules say.

This being said I'm certain private insurers will follow suit and they may not have the foresight to include such a restriction in their provider contracts.