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The new Medicare rules assuming causation

Posted on Aug 20, 2007

The new Medicare rules assuming causation Aug 20, 2007 in Medicare I don’t think I’ve ever seen as much blogosphere reaction to a single medmal issue. It was just announced that Medicare will no longer cover certain medical expenses–expenses they assume are caused by hospitals and doctors. So far I’ve found reactions from Medpudit Disappearing John RN Range1MD Medinnovationblog Kevin MD I would not be surprised if there aren’t more people commenting out there (actually, Kevin MD links to some I hadn’t seen), but these are the ones from blogs I track at this point in time. Here is the issues, as reported in the New York Times story, “Medicade Says It Won’t Cover Hospital Errors.” WASHINGTON, Aug. 18 — In a significant policy change, Bush administration officials say that Medicare will no longer pay the extra costs of treating preventable errors, injuries and infections that occur in hospitals, a move they say could save lives and millions of dollars. Private insurers are considering similar changes, which they said could multiply the savings and benefits for patients. Under the new rules, to be published next week, Medicare will not pay hospitals for the costs of treating certain “conditions that could reasonably have been prevented.” Among the conditions that will be affected are bedsores, or pressure ulcers; injuries caused by falls; and infections resulting from the prolonged use of catheters in blood vessels or the bladder. In addition, Medicare says it will not pay for the treatment of “serious preventable events” like leaving a sponge or other object in a patient during surgery and providing a patient with incompatible blood or blood products. “If a patient goes into the hospital with pneumonia, we don’t want them to leave with a broken arm,” said Herb B. Kuhn, acting deputy administrator of the Centers for Medicare and Medicaid Services. The new policy — one of several federal initiatives to improve care purchased by Medicare, at a cost of more than $400 billion a year — is sending ripples through the health industry. It also raises the possibility of changes in medical practice as doctors hew more closely to clinical guidelines and hospitals perform more tests to assess the condition of patients at the time of admission. Hospital executives worry that they will have to absorb the costs of these extra tests because Medicare generally pays a flat amount for each case. Doctors do not think that this policy shows much wisdom. As the Medpunit headlines, “You Broke It, You Bought It: The new Medicare denial model.” He writes, It’s probably reasonable to expect a hospital and surgeon to remove a left behind sponge at now added charge, but some of these conditions are difficult to avoid. Patients who require chronic urinary catheters, for instance, are notoriously prone to infection despite the best efforts to avoid them. And dying, chronically ill patients are prone to bed sores despite the best efforts to prevent them. It seems likely to me (and to all the medical bloggers I’ve read) that hospitals are going to be pressured to avoid treatments that are likely to lead to these complications. Unless they resist this pressure, the Medicare rules will mean that patients will be creatively refused access or that needed medical procedures will be denied because of the possible complications. But, as a medical malpractice blogger, the first thought that came to me is that this will have consequences in tort cases. Effectively, the government has just issued a list of things they claim are always the fault of doctors and/or hospitals. If this list is upheld we can expect to see more medmal lawsuits on the basis of this list. So far, the only medical blogger I’ve seen mention this problem is the Medinnovationblog. It will be interesting to see if attorneys appeal to the list in future lawsuits.