News in brief - Sept. 17, 2007

Medicare puts hospital-preventable conditions on no-pay list

The Centers for Medicare & Medicaid Services will not pay for eight hospital-acquired conditions it says are preventable, according to a final rule it issued last month. Starting in fiscal year 2008, Medicare will not pay the added costs associated with the following: objects left behind in surgery, air embolisms, delivery of incompatible blood or blood products, patient falls in the hospital, decubitus ulcers not present on admission, catheter-associated urinary tract infections, vascular catheter-associated infections, and mediastinitis after coronary artery bypass graft surgeries.

Medicare will propose adding six more conditions -- ventilator-associated pneumonia, deep vein thrombosis, Clostridium difficile-associated disease, methicillin-resistant Staphylococcus aureus and Staphylococcus aureus septicemia -- to the no-pay list in fiscal year 2009. Both the American Hospital Assn. and the AMA filed comments objecting to at least some of the conditions Medicare proposed in May because they could occur even when physicians and hospitals correctly follow guidelines.

Consumer groups lauded Medicare for its decision. Patient safety experts said that although not every condition selected by Medicare is always preventable, they can be avoided most of the time.

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Medicare anesthesia payments lower than private rates

Medicare in 2004 paid an average of 67% less overall than private insurance companies for a set of seven anesthesia services, according to a new report. The Government Accountability Office looked at Medicare rates for 41 payment localities and found that the program paid 51% to 77% less than private payers. Average Medicare payments only ranged from $177 to $303, while private insurance payments for the seven anesthesia services ranged from $472 to more than $1,300.

GAO said, however, that anesthesiologists are generally paid better than most types of physicians. Citing a survey by the Medical Group Management Assn., the oversight agency noted that the 2005 median compensation for anesthesiologists of more than $350,000 was more than 10% higher than the figure for specialists and more than twice the figure for generalists.

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ASCO asks Medicare to drop anemia drug limits

The American Society of Clinical Oncology officially asked federal officials to lift Medicare's recently finalized restrictions on the coverage of anemia drugs in cancer patients. In a written request, ASCO said the new rules on the anemia drugs epoetin and darbepoetin restrict physicians' ability to give their cancer patients the best treatment possible. Medicare will continue covering the medications for patients whose anemia is caused by chemotherapy, but only under strict conditions, such as when a patient's hemoglobin levels go below 10g/dL.

In recent months, safety concerns with the drugs, which have been linked to heart attacks and strokes in some patients, have prompted the Food and Drug Administration and the Centers for Medicare & Medicaid Services to try to rein in potential overuse by physicians.

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