'Never Events' Occur but Medicare Won't Pay


As of Oct. 1, 2008, Medicare has stopped paying hospitals for care resulting from never events, which refers to medical mistakes that should never occur, such as doctors leaving sponges inside patients.

If there could be good news for those who are insured by Medicare and recipients of medical errors, it's that Medicare also bans the hospital from charging the patient for the medical mistake.

According to Medicare's Web site, some of the "never events" Medicare won't pay for include injuries related to:

  • falls and traumas occurring during a hospital stay;
  • foreign objects like sponges or medical instruments being left in bodies after surgery;
  • infections due to some types of catheters;
  • advanced bedsores;
  • blood air bubbles that form after surgery;
  • poor hospital diet reactions (such as diabetic comas occurring due to poor sugar control);
  • surgical site infections from some surgeries;
  • wrong blood type transfusions; and
  • blood clots forming due to surgery.

But the new Medicare regulations aren't projected to save Medicare that much money.

In fact, it's expected that Medicare will save only about $21 million a year by refusing to cover the "never events," which is a small percentage of the total money Medicare spends on hospital care.

For example, Medicare paid $110 billion for inpatient care last year, according to The New York Times.

The article goes on to discuss that financial savings isn't the main reason for the Medicare turnabout-the main reason for the change is the message that it sends.

The Times article continued to say that the Medicare change carries a "great symbolism in the Bush administration's efforts to revamp the country's medical system."

The Bush administration has been criticized for escalating Medicare costs by creating initiatives that reward quantity of care over quality of care.

This move is meant to reduce medical errors in hospitals by pressuring hospitals to be more careful. Basically, if they mess up, they'll be the ones that pay.

Last year, there were 193,566 injuries from inpatient falls and trauma, 44,465 infections that resulted from catheters, and 750 incidents of foreign objects left in people after surgery, according to the Centers for Medicare and Medicaid Services.

Private Insurance May Follow Medicare's Lead

Some people are concerned that private health insurance companies will follow Medicare's lead. Although Medicare restricts hospitals from charging patients, private insurance companies may not have that same influence.

This could potentially lead to affected patients having to fight the hospitals that injured them.

The Orlando Sentinel reports that Blue Cross Blue Shield of Florida plans to follow in Medicare's footsteps and stop paying for some errors during hospital stays.

New Medicare Policy Is 'Flawed'

The American Medical Association (AMA) has said that the new policy is flawed because some patients come to the hospital with preexisting conditions that don't become visible until after treatment has started.

It further said that even with the best medical care, some patients would still have medical complications, according to the Sentinel.

In a written objection to Medicare, AMA executive vice president Michael D. Maves said that the term never event "is extremely confusing... because it implies that the occurrence of the proposed [conditions] are always a mistake that should not have happened, when in fact, the condition may not have been avoidable."

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