Medicare Won't Cover Hospital Mistakes

Aug. 19, 2007 — -- Starting next year, if a surgeon leaves an instrument inside a patient, Medicare won't cover the cost of fixing that mistake.

Under new rules issued in the beginning of August, Medicare will no longer pay for the costs of what it considers "preventable" conditions acquired in the hospital. These include everything from certain types of hospital-acquired infections, to patients who are given transfusions with the wrong blood type, to bed sores.

Instead, the hospitals themselves will have to cover these costs (since the rules also prevent them from billing the patient).

Consumer advocates believe the change will give hospitals a much stronger incentive to try to prevent those mistakes in the first place.

"Every year, millions of Americans suffer needlessly from preventable hospital infections and medical errors," said Lisa McGiffert, director of Consumers Union's Stop Hospital Infections campaign, in a statement.

"These new rules are a good beginning for Medicare to use its clout to mobilize hospitals to improve care and keep patients safe."

The biggest impact could be on hospitals' efforts to prevent infections.

The Centers for Disease Control and Prevention estimates that 2 million patients get hospital infections each year, at a cost of more than $27 billion. Nearly 100,000 of those infections are fatal.

According to McGiffert, many of these could be prevented if hospitals did a better job of following simple infection control procedures, including having doctors and nurses wash their hands between every patient.

The new rules will also save taxpayers millions of dollars each year, according to Jeff Nelligan, a spokesman for the Centers for Medicare and Medicaid Services. "If you increase the quality [of care], it's not only better for the beneficiary, it's better for the taxpayer," he said.

Medicare provides health coverage for 43 million elderly and disabled Americans. The program's expenses totaled over $400 billion in 2006, but those figures are expected to balloon in coming years as the baby boom generation ages.

Nelligan cast the new rules as part of a larger shift toward making Medicare more efficient. Medicare is "becoming an active purchaser, not just a passive payer," he said.