Big News from Medicare

Medicare is no longer going to pay hospitals from costs arising from "preventable errors" and "serious preventable events."

What are preventable errors?   The Washington Post story on the subject says this:  "bedsores, or pressure ulcers; injuries caused by falls; and infections resulting from the prolonged use of catheters in blood vessels or the bladder."

Serious preventable events?  They are events that should not occur during a hospital stay such as  "leaving a sponge or other object in a patient during surgery and providing a patient with incompatible blood or blood products."

The cost cannot be passed on to patients – the rules say  “[t]he hospital cannot bill the beneficiary for any charges associated with the hospital-acquired complication.”

Here is a copy of the new regulations.  The discussion starts at Page 290.

Question: if the federal government has defined an error or event as preventable is it negligence per se for that event to occur?  Why should it be necessary to employ an expert if the government, after a deliberate rule-making process, has determined that such errors or events should not occur?

How big is the problem?  Well, read this about objects left in a patient after surgery:

"For FY 2006, there were 764 cases reported of Medicare patients who had an object left in during surgery reported as a secondary diagnosis. The average charges for the hospital stay were $61,962. This is a rare event. Therefore, it is not high volume. However, an individual case will likely have high costs, given that the patient will need additional surgery to remove the foreign body. Potential adverse events stemming from the foreign body could further raise costs for an individual
case."  Page 317.

Don’t you think this is pretty strong language that would support a negligence per se instruction?

"Prevention guidelines – There are widely accepted and clear guidelines for the prevention of this event. This event should not occur. Prevention guidelines for avoiding leaving objects in during surgery are located at the following Web site:

http://www.qualityindicators.ahrq.gov/psi_download.htm.