Medicare stops paying hospitals for preventable conditions

November 1, 2008

Medicare stopped paying hospitals for the added cost of treating patients who are injured in their care.

Last month Medicare stopped paying hospitals for the added cost of treating patients who are injured in their care, according to The New York Times (10/1/2008). The nation's largest insurer compiled a list of 10 "reasonably preventable" conditions for which it now refuses payment, including incompatible blood transfusions, treatment of infections after certain surgeries, a second surgery to remove a left-behind sponge, serious bed sores, and injuries from falls and urinary tract infections caused by catheters. The regulations could apply to several hundred thousand of the 12.5 million hospital stays Medicare covers annually. The policy also would prohibit hospitals from billing patients directly for costs generated by medical errors.

Other insurers, both public and private, have similar restrictions in place. Last year, four state Medicaid programs announced that they will not pay for as many as 28 events. Some of the country's largest commercial insurers, including WellPoint, Aetna, Cigna, and Blue Cross Blue Shield plans in seven states, have similar restrictions. In addition, some state hospital associations have brokered voluntary agreements that members will not bill for medical errors. Maine is the first state to pass a statute banning the practice.