Yesterday's Associated Press report, released under the headline, "Medicare won't pay for hospital mistakes," on Yahoo! News, raises more questions than it answers. From a chronological point of view, the beginning of the story was postponed until the end of the report:
Last year, Mark McClellan, then director of the Medicare and Medicare programs, said the government could save hundreds of millions of dollars a year if the Medicare program stopped paying for medical errors such as operations on the wrong body part or mismatched blood transfusions.
About the only thing wrong with this proposition is that no one had thought of it (or had the intestinal fortitude to implement it) sooner. After all, negligence in matters of fiscal accountability is probably one of the major reasons why health care is in the mess it is now in. The result is a new rule that identifies several hospital procedures that will no longer be eligible for Medicare payments:
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.
The Centers for Medicare and Medicaid Services said it also would work to add three more conditions to the list next year.
Reading these paragraphs reminded me of Bob Newhart's old routine about those vending machines that sold flight insurance policies in most airports. The punch line was, "Buy the damned thing, if it make's you feel better; but, for God's sake, don't read the policy!" There is nothing like being told what might happen to you when your in a plane, and the same seems to be true of going to the hospital.
Nevertheless, this is still an incomplete story, since every hospital procedure has to be accounted for by the billing system. The rule recognizes this fact but not in a particularly comforting way:
Hospitals in the future will be expected to pick up the cost of additional treatment required by a preventable condition acquired in the hospital.
"The hospital cannot bill the beneficiary for any charges associated with the hospital-acquired complication," the final rules say.
This much is clear: Medicare won't pay; and "the rule" states that the patient cannot be billed. So what happens? Are those entries in the billing system logged as bad debts for tax purposes? Is the hospital truly bound by that rule, or will it find loopholes through which the patient can be billed? Or will the hospital just raise all of its rates to absorb these new expenses, meaning that, in the grand scheme of things, both Medicare and the patients will continue to pay for those errors?
From an objective point of view, we are probably talking about something that can be covered by malpractice insurance; but, as far as I have been able to determine from the news, this is just another ingredient in that whole stew that is the current health care mess. It is as if everyone recognizes how bad the system has become, yet no one has the will to clean up the mess. This is very much a time to reflect on the connotation of that phrase that Vonnegut made so famous, "So it goes."
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