Oct. 1, 2008 - New federal regulations to restrict
Medicare payments to hospitals for the extra care required to treat
patients harmed by certain preventable infections and medical errors
that occur at the hospital go into effect today. The rules adopted by
the Centers for Medicare and Medicaid Services (CMS) aim to provide
hospitals with a financial incentive to improve patient care.
Medicares new policy sends a powerful message to
hospitals that harming patients will harm their bottom line, said Lisa
McGiffert, Director of Consumers Unions Stop Hospital Infections
campaign (www.StopHospitalInfections.org).
Adding 43 new quality measures on which hospitals
have to report data in order to receive full payment for services
April
15, 2008 - The screws are being significantly tightened to improve the
care of Medicare patients in the hospital and to save millions of
dollars for Medicare... Read
more...
This policy will help prevent needless suffering
and deaths and ultimately ensure that the health care taxpayers pay for
is safe and effective.
Under the new regulations, CMS will withhold
payments to hospitals for care needed after patients suffer from certain
hospital acquired urinary tract infections; certain bloodstream
infections and select surgical site infections - specifically from
coronary artery bypass graft (CABG), certain weight loss surgery
(laparoscopic gastric restrictive surgery and gastroeneterostomoy), and
orthopedic procedures (spine, neck, shoulder, elbow).
Other hospital acquired conditions to be covered
include serious bed sores, objects left in patients bodies following
surgery; blood incompatibility; air embolism; deep vein
thrombosis/pulmonary embolism (formation/movement of a blood clot)
following total knee and hip replacement; falls and trauma (such as
burns and electric shock); and extreme blood sugar derangement.
The new Medicare regulations include protections to
prevent hospitals from billing patients when payments are withheld and
to minimize avoidance of patients perceived to be at risk for
infections.
The CMS rules clearly state that hospitals cannot
bill patients for the amount that Medicare refuses to pay, said
McGiffert. The federal government needs to make sure these protections
are enforced so patients are treated fairly. And Medicare should be on
the lookout for hospitals that try to game the system by falsifying
codes to avoid nonpayment.
Consumers Union has urged CMS to clarify how it
intends to monitor implementation of the news rules and respond to
patients who are unfairly billed in these situations. The group has
called on CMS to develop an expedited review process for claims from
patients who have been harmed by their medical care.
