Medicare won't pay hospitals for errors

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Medicare won't pay hospitals for errors

By LAURAN NEERGAARD

AP Medical Writer

Tue Feb 19, 5:20 PM ET

 

 

It's a new way to push for patient safety: Don't pay hospitals when

they commit certain errors. Medicare will start hitting hospitals

where it hurts in October, and other insurers are hot on the trail.

 

 

That has the nation's hospitals exploring innovative programs to

prevent injury and infection: Hand-washing spies. Surgical sponges

that sound an alarm if left in the body. Even a room sterilizer that

promises to wipe out bacteria left lurking on bedrails.

 

 

" Money talks, " says Dr. Steven Gordon, infectious disease chief at

the

Cleveland Clinic Foundation. " Every hospital CFO, this gets their

attention. "

 

 

And patients' first sign that something is changing may involve

lessening of a big indignity: Today, one in four hospitalized

patients

is outfitted with a urinary catheter. The tubes trigger more than

half

a million urinary tract infections a year, the most common hospital-

caused infection.

 

 

Yet many patients don't even need catheters -- they're an automatic

precaution after certain surgeries -- and many who do have them for

days longer than necessary. Why? The University of Michigan reported

the first national study of catheter practices last month, finding

nearly half of hospitals don't even keep track of who gets one. Fewer

than one in 10 hospitals does a daily check to see if the catheter is

still needed, a simple but proven infection-reducing system.

 

 

With those infections topping Medicare's do-not-pay list, Gordon says

hospitals already are beginning to get choosier about who needs

catheters, and to yank them faster.

 

 

Even when a hospital makes a preventable error, it still can be

reimbursed for the extra treatment that patient will now require.

Some

errors can add $10,000 to $100,000 to the cost of a patient's stay.

 

 

Beginning Oct. 1, Medicare no longer will pay those extra-care costs

for eight preventable hospital errors, including catheter-caused

urinary tract infections, injuries from falls, and leaving objects in

the body after surgery. Nor can hospitals bill the injured patient

for

those extra costs.

 

 

Next year, Medicare will add three more errors to the no-pay list;

ventilator-caused pneumonia and drug-resistant staph infections are

top candidates.

 

 

Medicare, which insures about 44 million elderly and disabled people,

estimates the move will save the government about $190 million over

five years.

 

 

It also sparked a movement: Private insurance giants like Aetna are

moving to make hospitals absorb the cost of serious errors.

Pennsylvania last month said it would follow Medicare's example and

stop Medicaid payments, too. The American Hospital Association is

urging members to voluntarily quit billing for treatment of serious

errors, and hospitals in a number of states, from Minnesota to

Vermont, have announced they will.

 

 

Many hospitals already were trying to improve patient safety for a

bigger reason -- to prevent suffering and death -- and a question is

whether making them literally pay for mistakes will spur greater

improvements. But some novel attempts are under way:

 

 

_A standard mop-and-bucket cleaning leaves bacteria in hospital

rooms,

especially on electronic equipment that janitors hesitate to touch.

So

the Wellmont Health System in Kingsport, Tenn., is testing a portable

machine that sterilizes a closed room by spewing out vaporized

hydrogen peroxide that reach into every nook and cranny.

 

 

STERIS Corp.'s VaproSure is proven to eliminate tough germs; it has

long been used in sterile manufacturing facilities, and even helped

clean buildings tainted in the 2001 anthrax attacks.

 

 

But doctors, nurses and others bring new germs into rooms every time

they enter, raising the question of whether sterilizing between check-

 

ins will really lead to fewer infections.

 

 

" There's no question they can sterilize a room, " Wellmont chief

executive Dr. Richard Salluzzo says of the $180,000 machines. " Has it

prevented infection? We don't have the answer to that yet. "

 

 

He hopes to have enough data to tell by year's end.

 

 

_Nurses count surgical sponges to make sure they're all out before a

patient is sewn up, but every hospital occasionally misses some. In

University of Michigan operating rooms, doctors are testing sponges

tagged with bar code-like radiofrequency chips. Wave a wand and a

beep

sounds if a sponge is still in the wound. Or, nurses can drop used

sponges into a " smart " bucket that counts how many are missing.

 

 

" We've had a long history in medicine of this problem continuing to

occur no matter what kind of very careful steps we've devised, " says

clinical affairs chief Dr. Darrell Campbell, a well-known patient

safety specialist. " We want to get to zero. "

 

 

_In U-Michigan's hospital halls, physician assistants are assigned to

spy to tell if fellow workers wash hands both when entering and

exiting patient rooms. Workers are better at remembering on the way

in, but they don't want to carry germs back to the nurses' station or

elevator buttons, either, Campbell notes. Some bugs can live on cool

hospital surfaces for weeks.

 

 

There is some concern that the no-pay push could make hospitals try

to

hide certain errors, or just trade one problem for another. Pull a

urinary catheter too soon, for example, and a fragile patient may

fall

going to the bathroom, says Michigan's Campbell.

 

 

" I don't know how much is really preventable, " adds the Cleveland

Clinic's Gordon. " We want to chase zero, but we'll probably never get

to zero. "

 

 

___

 

 

Lauran Neergaard covers health and medical issues for The Associated

Press in Washington.

 

 

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