Medicare Will Not Pay for Preventable Conditions Acquired at Hospitals

Medicare no longer will reimburse hospitals for the treatment of preventable errors, injuries and infections that occur in the facilities under a new rule scheduled for publication this week, a move that CMS officials said could save lives and millions of dollars, the New York Times reports. Under the rule, Medicare no longer will reimburse hospitals for the treatment of certain "conditions that could reasonably have been prevented," and the facilities "cannot bill the beneficiary for any charges associated with the hospital-acquired complication" (Pear, New York Times, 8/19).

The eight conditions for which Medicare no longer will reimburse hospitals for treatment include: falls; mediastinitis, an infection that can develop after heart surgery; urinary tract infections that result from improper use of catheters; pressure ulcers; and vascular infections that result from improper use of catheters. In addition, the conditions include three "never events": objects left in the body during surgery, air embolisms and blood incompatibility (USA Today, 8/20).

The rule, proposed by CMS in April and mandated by a 2005 law, will take effect in October 2008. CMS officials said that next year they plan to add three additional conditions to the list (Zhang, Wall Street Journal, 8/20).