Published in the October 2007 issue of Today’s Hospitalist
By now, you’ve probably heard that Medicare is raising the bar on medical errors. Starting in fall 2008, Medicare will refuse to pay costs related to treating “preventable inpatient complications.” That category includes everything from objects left in patients during surgery to patient falls.
As our coverage analysis explains, the regulation takes the common-sense view that Medicare should not pay for the mistakes that hospitals make. Hospitals will still be paid for the patient’s primary diagnosis, but they will get nothing when these conditions are billed as a secondary diagnosis.
It seems reasonable to not pay a hospital for complications caused by a surgeon leaving a sponge in a patient. It’s more difficult, however, to argue that some of the conditions spelled out by the regulation are in fact “preventable.” How can Medicare be sure, for example, that your patient contracted that UTI in the hospital and wasn’t admitted with an infection?
There are concerns about the downsides of the regulation, including questions about how hospitalists who are compensated on productivity will bill- “and get paid- “for treating these complications. But one upside is that the regulation promises to give a boost to the quality improvement movement. If they haven’t already, hospitals everywhere should get serious about reducing complications when they have to start covering the hefty costs of treating those complications.
The regulation also promises to be a great opportunity for hospitalists to prove “and increase “their value to hospital leadership. Because so many items on the no-payment list are conditions that hospitalists treat every day, the specialty will be in an excellent position to help hospitals deal with a potentially devastating rule change.
What do you think of the new Medicare regulation and its potential effect on hospitalists? To make your voice heard “and read what your colleagues think “go to the Today’s Hospitalist Web site and look for the Sound Off feature on the right side of the page. We’d like to hear your opinions, and find out how your program plans to respond.
Editor and Publisher