New Medicare Cuts Spell Complications For The Elderly, The Sick, and the Overweight

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Medicare's Shameful CutbacksAs of October 1, 2008, Medicare will no longer pay for what it terms are “never events,” that is, events that should never happen. The way the thinking goes, in refusing to pay for “mistakes,” Medicare will actually reduce the number of medical mistakes that occur. The ridiculousness of this position cannot be underestimated.  Never mind that Medicare cannot produce any evidence that refusing to pay for mistakes reduces mistakes - logic is not required when setting rules that save the insurer money; logic is only required when the patient is paying money....and this new rule means that will be occurring more and more. Think that because you don’t have Medicare this won't affect you? Think again - new Medicare payment rules usually have a trickle down effect among private insurers, who rationalize to their protesting members "Medicare is doing it."

So just what are these “never events”?  According to Medicare they are mistake so easy to prevent that it never should occur. Remember - the mistakes are made by the doctor or hospital staff, and they negatively affect only the patient - and now the patient gets the added bonus of being the sole payer for the mistake that should have been prevented, with very little recourse to sue the doctor or hospital to get back the payment for same (in California, no matter what the mistake ends up costing the patient with the insurer, the patient is limited to court payday of less than $300,000.  

According to the Center for Medicare and Medicaid Services, these seven conditions are in the initial group characterized as “never events”:

•  pressure ulcer stages III and IV;

•  falls and trauma;

•  surgical site infection after surgery for obesity, certain orthopedic procedures, and heart bypass surgery;

•  intravenous-catheter associated infection;

•  bladder catheter-associated urinary tract infection;

•  administration of incompatible blood;

•  air embolism; and

•  foreign object unintentionally retained after surgery.

Of these “never events,” only three are medical mistakes. Of course we can all agree that instruments and sponges should never be left inside a patient  after surgery; of course we can all agree that no one should ever receive the wrong blood type/match in a transfusion; of course we can all agree that no one should ever ever have air introduced into the bloodstream when receiving a shot or an IV.  Yes, of course we can agree that proper hospital procedures would  prevent all three of these incidents.  But if they don't, guess who pays in terms of their health and their wallet? That's right - you.

The other five events are what boggle my mind.  In a perfect world, they can certainly be termed 'events that shouldn't happen for the health and wellbeing of all" - but what they should appropriately be called is what they are: known complications of hospitalization or illness. These things - post surgical infection, for example -  are going to happen no matter what, and even despite best efforts to prevent them. They cannot be prevented 100% of the time.  Nevertheless, Medicare plans to save money by simply refusing to pay for them.

With the institution of the new Medicare Is Never Paying For Never Events rule, the patient will now be paying for the treatments and extended hospital stay that result from infections, bed sores, and falls.

The elderly are prone to falling. In fact, they are often in the hospital to begin with because of a fall. There isn't really anything anyone can do to make an elderly person less likely to fall,short of tying them to the bed  (but that of course will raise bed sores, a further expense for the patient). 

Now let's consider infection as a result of surgery.Hospitals certainly know that those are who most ill or most frail are more likely to suffer infections. What do you think a hospital will do, now that it knows it won't be reimbursed by Medicare for infections that are impossible to prevent? I'll tell you - they will simply refuse to admit patients that are likely to get infections.  That is, they will refuse to surrealistically admit the most sick, the most frail.  This of course guarantees that elderly won't get admitted, and adult children everywhere will find themselves struggling to pay for home health care nursing, or letting their parents sicken to the point of needing emergency care - a hospital can't refuse