Medicare plans to stop paying for 6 hospital-acquired conditions

Besides those on the list for 2008, seven more conditions are under consideration for 2009.

By Kevin B. O'Reilly, AMNews staff. June 18, 2007.

The country's payment system offers hospitals little financial incentive to prevent complications because they stand to make more money for treating the conditions patients acquire during their stays, patient safety advocates charge. A newly proposed Centers for Medicare & Medicaid Services rule aims to change that.

The rule, proposed last month and set to go into effect in October 2008, would deny Medicare payment for six costly and sometimes deadly preventable hospital-acquired conditions. The proposal comes in response to a 2003 Medicare Modernization Act requirement that the secretary of Health and Human Services choose at least two hospital-acquired conditions that are costly or happen often and result in higher pay for hospitals. Medicare also is seeking comment on seven additional hospital-acquired conditions that could be added to the no-pay list in 2009.

The initial six conditions include: pressure ulcers, two hospital-acquired infections (catheter-associated urinary tract infections and Staphylococcus aureus septicemia) and three "never events" (air embolism, blood incompatibility and object left behind in surgical patient).

"These reforms represent CMS' continued push to become a more active purchaser of high-quality care for Medicare beneficiaries," CMS Acting Administrator Leslie V. Norwalk said in a statement.

Employer and consumer groups hailed the move and said they hope private payers will follow in Medicare's footsteps. Hospitals and physician patient safety experts approved of the general idea but cautioned that Medicare be careful not to encourage gaming or punish hospitals for events outside their control.