No More Medicare Payments for Medical Errors; Medicaid, Private Payors Follow Suit

Thursday, October 2nd, 2008
This post was written by Melanie Matthews

Starting October 1, Medicare no longer reimburses hospitals for a set of “never events” — reasonably preventable medical errors that CMS deems should never happen to a patient while hospitalized. A New York Times article describes the impact of this Congressional ruling on the quality of care for hospitalized patients and its repercussions in the Medicaid and commercial populations.

Medicare, which provides coverage for the elderly and disabled, has put 10 “reasonably preventable” conditions on its initial list, saying it will not pay when patients receive incompatible blood transfusions, develop infections after certain surgeries or must undergo a second operation to retrieve a sponge left behind from the first. Serious bed sores, injuries from falls and urinary tract infections caused by catheters are also on the list.

Over the last year, four state Medicaid programs, including New York’s, have announced that they will not pay for as many as 28 “never events” (so called because they are never supposed to happen). So have some of the country’s largest commercial insurers, including WellPoint, Aetna, Cigna and Blue Cross Blue Shield plans in seven states.

Under this ruling, hospitals may no longer bill Medicare patients for charges related to these events, either.

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