October 1, 2008

New Medicare Rules Mean No Reimbursement for "Hospital Acquired" Medical Complications

New Rules effective October 1, 2008, will mean that the Centers for Medicare and Medicaid (CMS) will no longer reimburse for medical expenses that are a result of hospital-acquired medical complications or medical errors, and this is expected to bring a significant increase in litigation between hospitals, patients, physicians alike.   CMS based its decision to halt payments for so-called “never events” on its belief that it would help improve the quality of care in hospitals and limit medical errors that result in serious complications for patients which may include pressure ulcers, falls/trauma, catheter-associated urinary tract infections, catheter-associated infections, surgical site infection following certain types of surgeries, blood incompatibility, just to name a few.  As of October 1st, if the condition is not present upon admission but acquired during a hospital stay, Medicare will no longer pay the additional cost of hospitalization, nor can the hospital be allowed to require the patient to be responsible for the cost.  According to a 1999 Institute of Medicine report, “never events” account for 98,000 deaths a year at a cost in excess of $37 million dollars.

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