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Medicare Will No Longer Pay For "Preventable Hospital Errors"

Starting October 1, 2008, Medicare will no longer pay for certain hospital acquired conditions (errors, injuries, and infections) that could "reasonably have been prevented." (The New York Times article is here. The large pdf file of Medicare reimbursement rules is here; see page 290 for the new guidelines.)

The conditions that will no longer be covered include infections from urinary catheters, infections from central venous catheters, pressure ulcers, objects left in the body after surgery, air embolism, injuries from blood incompatibilities, mediastinitis as a complication of heart surgery, and falls.

Other conditions that could be added to the list in the future include surgical site infections, ventilator-associated pneumonia, Staph aureus bacteria, methicillin resistant Staph aureus infection, deep venous thrombosis, and Clostridium difficile colitis.

This is a complicated issue, and I have mixed feelings about the new rule. On the one hand, complications are the sometime unavoidable result of the use of medical devices like ventilators and intravenous catheters. On the other hand, as the Medicare rule outlines in the discussion, many of the conditions they list are potentially preventable. For example, the guidelines from the Centers for Disease Control for prevention of catheter-associated urinary tract infections are here and the guidelines for prevention of catheter-related bloodstream infections are here. One argument in favor of the Medicare rule is that it would encourage more hospitals and health care professionals to adhere to the guidelines, which could potentially save lives and reduce health care costs. Unfortunately, I fear that many of these complications may not be preventable, even when guidelines are followed, and the rule is merely an attempt to further reduce payments to hospital systems that are already on shaky ground financially.
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Dr. Schwimmer's blog explores the intersection of medicine, new technologies, and the Internet.