Medicare considers expanding nonpayment rules

Campaigns


Thursday, June 19, 2008

Consumers Union Supports Proposed Expansion of Medicare Policy
to Withhold Payments to Hospitals That Harm Patients

Non-Payment Plan Aims to Reduce Preventable
Hospital Acquired Infections & Medical Errors

WASHINGTON, D.C. – The federal government should expand its effort to restrict Medicare payments to hospitals for the cost of health care associated with certain infections and medical errors acquired during treatment, according to Consumers Union, the nonprofit publisher of Consumer Reports.
Last year, the Centers for Medicare and Medicaid Services (CMS) adopted new rules that will end payments to hospitals for the extra care required to treat patients harmed by certain preventable hospital acquired conditions. Now the agency has proposed expanding the list of preventable conditions covered by the non-payment rules.
In comments submitted to the Centers for Medicare and Medicaid Services (CMS), Consumers Union said that a proposal by the agency to limit such payments would provide hospitals with a strong new financial incentive to improve patient care. Consumers Union urged CMS to strengthen the proposed regulations by expanding the types of preventable hospital acquired conditions that would result in lower Medicare payments and to clarify protections to ensure patients are treated fairly and get the care they need.
“By restricting payment for preventable medical errors and hospital acquired infections, Medicare is sending a powerful message to hospitals that harming patients will harm their bottom line,” said Lisa McGiffert, Director of Consumers Union’s Stop Hospital Infection’s campaign (www.StopHospitalInfections.org). “This effort will ultimately save money and lives by motivating hospitals to follow long-standing patient safety practices that are too often ignored.”
The nonpayment rules adopted by CMS last year cover certain urinary tract infections, staph aureaus bloodstream infections, and four other hospital errors unrelated to infections: serious bed sores, objects left in patients’ bodies following surgery, blood incompatibility, and air embolism. These rules will go into effect on October 1.
Under the proposed regulations for 2009, Medicare would expand this policy by withholding payments to hospitals for the extra care associated with treating certain surgical site infections (specifically for total knee replacement, laparascopic gastric bypass and gastroeneterostomoy, and ligation and stripping of varicose veins); Legionnaires’ disease (a type of pneumonia caused by a specific bacterium); extreme blood sugar derangement; Iatrogenic pneumothorax (collapse of the lung) delirium; ventilator-associated pneumonia; deep vein thrombosis/pulmonary embolism (formation/movement of a blood clot); staphylococcus aureus septicemia (bloodstream infection); and Clostridium difficile associated disease (a bacterium that causes severe diarrhea and more serious intestinal conditions such as colitis).
“Taxpayers spend billions of dollars every year covering the cost of preventable hospital errors and infections,” said McGiffert. “Restricting Medicare payments for these hospital acquired conditions will help ensure that taxpayer dollars pay for safer and more effective health care.”
Consumers Union urged CMS to expand its current proposal by adding two more hospital acquired infections to the nonpayment list: Methicillin-resistant Staphylococcus aureus (MRSA) infections, and infections associated with hip replacement surgery.
Consumers Union also recommended adding preventable readmissions to the non-payment policy. The Medicare Payment Advisory Commission found that almost 18 percent of Medicare hospital patients were readmitted within 30 days of discharge, at a cost of $15 billion to Medicare. The Commission concluded that 76 percent of readmissions after 30 days are preventable. Finally, Consumers Union urged CMS to add a disclosure component to the non-payment policy so that the public could find out which hospitals are having payments withheld because of preventable harm to patients.
When CMS adopted the initial non-payment rules last year, it included protections to prevent hospitals from billing patients when Medicare payments are withheld, and to prohibit hospitals from avoiding patients perceived to be at risk for infections. But Consumers Union raised concerns that these protections remain vague and should be clarified to ensure patients harmed by hospital acquired conditions aren’t billed for the extra care associated with treating them.
“We remain concerned that there are no details regarding how Medicare intends to monitor and respond to patients who are unfairly billed or unfairly treated in these situations,” said McGiffert. “Medicare should develop an expedited review process for claims from patients who have been harmed by their medical care.”
Lisa McGiffert: 512-477-4431, ext 115
Michael McCauley: 415-431-6747, ext 126
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