Medicare to stop paying for mistakes caused by hospitals

URBANA – Nobody goes to the hospital expecting to get sicker.

But mistakes can happen.

A patient falls out of bed and gets hurt. An infection can set in after surgery. Bedsores can worsen.

Currently, Medicare picks up the tab for the conditions patients acquire while they're in the hospital – things that could have been prevented, such as injuries from falls and surgery-site infections.

But starting Oct. 1, hospitals will have to absorb those extra costs. And they won't be allowed to bill the patients for them, either.

The change is expected to save Medicare $21 million a year, but it's not about the money, according to Ellen Griffith, a spokeswoman for the U.S. Centers for Medicare and Medicaid Services.

It's about encouraging a higher standard of care by identifying some complications that are reasonably preventable if a hospital does what it should – for example, making sure hands have been washed before a catheter is inserted and leaving bedrails up for patients prone to falling, she said.

The change will also encourage hospitals to examine patients more carefully upon admission, especially for complications a patient may already have for which a hospital could later be held responsible.

"Hospitals now have a greater incentive ... to evaluate the patient more thoroughly at the start, and to keep a more careful eye on the patient throughout the stay," Griffith said.

Local hospitals contend they're already careful, and they don't expect to lose significant Medicare money as a result of the new rule.

"These are things that we've been tracking for years and years, and we don't think there's going to be that significant an impact on the hospital," said Laurence "L.J." Fallon, Carle Foundation Hospital's chief risk and quality officer.

In fact, in the case of a serious error, Carle has long absorbed the extra costs and not billed the patient or insurer, according to Rob Tonkinson, the hospital's chief financial officer.

Rosemary Meridith, director of quality and care management for Provena Covenant Medical Center, said Provena's hospitals in Urbana and Danville have also been taking steps for several years to improve quality and reduce the chance of errors.

At Covenant, for example, there's a blast of music – the old Beach Boys song "I Get Around" – every hour until bedtime to remind nurses to check on all their patients and see if there's anything they need. And the hospital's patient fall rate has dropped in recent years to below the national average, she said.

If visitors ask why they keep hearing this song, so much the better, Meridith said. Then the nurses have an opportunity to instruct friends and family members about the kinds of things to watch out for when they're alone with the patient.

Covenant and Provena United Samaritans Medical Center have also had a heightened focus on skin care to avoid pressure ulcers, or bedsores, she said.

Fallon said he thinks the new Medicare rule is fair, though there are some situations in which hospitals can be blamed for conditions that just aren't their fault.

For example: A lot of the damage that causes pressure ulcers can be done before the patient even arrives at the hospital, he said, and that can be more challenging than avoiding a mistake like leaving an object inside a patient's body after surgery.

Meridith said sometimes the patients themselves won't comply with practices that are intended to keep them safe. To name one: Some patients refuse to call a nurse for help getting out of bed, and then wind up falling.

And while there are bed alarms that alert a nurse to those times, Tonkinson said, "if you're in a patient's room that's the far corner from the nurse's station and you hear a bed alarm ring, that patient could be on the floor before anyone could humanly get there."

Still, he predicts the new Medicare rule will push hospitals to try harder.

The Illinois Hospital Association doesn't look for the new rule to be financially burdensome for the state's hospitals, according to association senior vice president Pat Merryweather.

That's partly due to how Medicare coverage works in general, she said. Rather than covering the actual cost of caring for each individual patient, the government reimburses hospitals based on the average cost of care for the condition, or combination of conditions, each patient has.

The payment for, say, a patient coming in for a coronary artery bypass graft would be bumped to a higher level if the patient arrived at the hospital with other conditions, such as diabetes, which could complicate the treatment. When a patient is already in that higher payment category, another new condition picked up in the hospital won't bump the payment down to the lower level, Merryweather said, and many Medicare patients come to the hospital with more than one condition that places them in a higher payment category.

Time will tell, she said, "but right now, the focus isn't on hospitals losing money. The focus is on the care of the patients."

Other patients also stand to benefit from better care standards for Medicare patients, because once hospital staffs become accustomed to doing things a certain way, they're bound to be exercise those practices with all patients, Griffith said.

"You establish the habits of quality of care, and that will have an overflow effect," she said.

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