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CMS: No Payments to Hospitals for Medical Errors

After studies revealed an estimated 98,000 deaths, year after year, the Medicare program is finally saying enough is enough, and implementing a significant incentive for hospitals to improve their deadly error rates. The Medicare program will halt reimbursing hospitals for treatment of preventable errors, injuries and infections that occur in facilities.

In August the Centers for Medicare and Medicaid Services (CMS) announced that “conditions that could reasonably be prevented” are no longer covered and the facilities can no longer bill the beneficiary for any charges associated with the hospital-acquired complication.
 
Since 1999, when the Institute of Medicine released its landmark report To Err is Human: Building a Safer Health System, there has been increased attention focused on the problem of preventable medical errors in hospitals. The authors of the report estimated that adverse events may cause as many as 98,000 deaths annually.

The increased scrutiny led some hospitals to make improvements, but a 2005 study in the Journal of American Medicine estimated that the death rate had continued to hold steady at 98,000 per year. That same year, HealthGrades Inc. reported that the deaths of almost 247,662 Medicare patients might have been prevented if hospitals had provided safer patient care.

Another study conducted beween 2003 and 2005 found that 1.16 million preventable patient safety errors occurred. Overall, Medicare patients who suffered a potentially preventable medical error had a one-in-four chance of dying.

These errors cost Medicare an additional $8.6 billion over the three study years.

The eight conditions for which Medicare no longer will reimburse hospitals for treatment include:

  • falls

  • mediastinitis

  • catheter-associated urinary tract infections

  • pressure ulcers

  • catheter-associated vascular infections

  • objects left in the body during surgery

  • air embolisms and

  • blood incompatibility.
     

Since the announcement by CMS, two states have adopted similar policies. Minnesota announced in September that the state’s hospitals have agreed to stop charging patients and insurers for certain medical errors as well as for follow-up care required because of the errors. The policy covers 27 errors that should never occur, known as “never events.” They include leaving in an object after surgery, burns, wrong site or wrong patient surgery, serious medication errors and bedsores.

Massachusetts announced in November that starting in 2008 it will not charge patients or insurers for serious adverse events. Initially the policy will cover nine events, defined as “serious” by the National Quality Forum. Once the program is implemented, the Massachusetts Hospital Association expects to expand the list.

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