SHINE Fact Sheet #34
Medicare Takes New Steps to Make Your Hospital Stay Safer
This article is being run in two parts in the October and November Good Life.
Medicare is taking new steps to ensure that when patients enter the hospital for treatment of one medical problem that they are not leaving the hospital with additional injuries, infections or other serious conditions that could have been prevented if the hospital had taken proper precautions. Although some complications may not be avoidable, Medicare is adopting payment policies that will encourage hospitals to set up procedures which reduce hospital-acquired conditions and preventable medical errors.
Hospital-acquired conditions are reasonably preventable and include:
- Foreign objects (such as sponge or needle) inadvertently left in patients after surgery
- Air embolism - an air bubble that enters the bloodstream and can obstruct the flow of blood to the brain and vital organs
- Transfusion with the wrong type of blood
- Severe pressure ulcers - deterioration of the skin due to the patient staying in one position too long so that the tissue under the skin is affected (Stage III) or that has become so deep that there is damage to the muscle and bone and sometimes tendons and joints (Stage IV)
- Falls and trauma - fracture, head injury, joint dislocation, crushing injury, burn, electric shock
- Catheter-associated urinary tract infection (UTI)
- Vascular catheter–associated infection
- Manifestations of poor control of blood sugar levels
- Surgical site infection following coronary artery bypass, certain orthopedic procedures and bariatric surgery for obesity
- Deep vein thrombosis (blood clot in a major vein) and pulmonary embolism (blockage in lungs) following certain orthopedic procedures
What Medicare is Doing:
Medicare has been collecting data on the first 8 conditions from hospitals since October 1, 2007, and as of October 1, 2008 will collect data on the remaining conditions. If at discharge there is a selected condition that was not identified by the hospital at admission or could not be identified based on data and clinical judgment at admission, then these will be considered hospital acquired. To encourage hospitals to avoid hospital-acquired conditions, Medicare will no longer pay for the increased costs of care that result from hospital-acquired conditions. Medicare prohibits the hospital from billing the beneficiary for the difference between the lower and higher payment rates.
Medicare will pay for physician and other covered items or services that are needed to treat the hospital acquired condition, including the costs of post-acute care that would not have been needed for the initial medical problem m, but are needed because of the hospital-acquired condition.
Medical Errors That Should Never Happen (“Never Events”)
These are events that should never happen in a hospital. They cause serious injury or death to the patient and are very costly for the patient and the Medicare Program. Some examples include:
- Surgery on the wrong body part
- Surgery on the wrong patient
- Wrong surgery on a patient
What Medicare is Doing:
In most cases, Medicare only pays for items and services that are reasonable and necessary for the treatment of the patient’s condition or certain preventive services required by the Medicare law. For the three examples listed above, Medicare is opening a National Coverage Decision process to look at how to ensure that patients get necessary care and to look at how to avoid paying the doctor and hospital for surgery performed in error.
Impact on the Patient
These policies should result in higher-quality care during a patient’s hospital stay. Hospitals will have additional incentives to make more thorough assessments at admission, to have systems in place to prevent adverse events from occurring during the hospital stay and to prevent erroneous surgery that is not needed or results in injury. If successful, these policies should reduce the frequency of hospital-acquired conditions and wrong site surgeries, which will provide better outcomes for patients and cost savings for the Medicare program.
For concerns about the quality received in a hospital, patients should call the quality Improvement Organization in the state (MassPRO at 1-800-252-5533).
Summarized from Centers for Medicare and Medicaid Services (CMS) Press Release August 4, 2008, CMS Office of Public Affairs
The SHINE program at Franklin County Home Care can help with your questions on health insurance, prescription drug plans and more. Please call 413-773-5555 or 978-544-2259 or .