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Archive for Tuesday, August 21, 2007

New policy may be costly

Consumers may foot bill for infections, medical errors

August 21, 2007

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A change in Medicare policy to no longer pay for hospital infections and medical errors has one Kansas health consumer group worried that the costs will be passed on to patients.

Corrie Edwards, executive director of the Kansas Health Care Consumer Coalition, questions who will eventually end up paying when hospitals pick up the tab for infections or errors that occur on their grounds.

"The reality is someone is going to have to pay for this, whether it is a write-off for the hospital or passed on to people who have insurance," Edwards said.

Although officials at Lawrence Memorial Hospital and Kansas University Hospital have concerns with the new policy, they say it shouldn't have much of an effect on their bottom lines.

"In terms of the general thrust of the being accountable for the quality of care you receive, that is something we feel we've already adopted," KU Hospital spokesman Dennis McCulloch said. "And because of that, we certainly don't fear a rule change or anything like that that will impact reimbursement."

Traditionally, McCulloch said, uncompensated care does get passed on to consumers. He points to malpractice lawsuits.

"That's why we say it's good business for hospitals to invest in the quality of care," McCulloch said.

The Centers for Medicare & Medicaid Services this month released new rules that will stop payment to hospitals for what it called "preventable conditions." Those conditions include falls, bedsores and infections that can occur at hospitals. The changes also cover medical errors made during surgery, such as objects left in the body, infusing someone with the wrong blood type and air embolism.

The changes will take effect in October 2008.

The regulations are among a list of reforms Medicare is making to its payment system to hospitals. Along with reducing costs, the changes also are aimed at improving hospital care.

According to the Centers for Disease Control and Prevention, there are 1.7 million health-care related infections each year, and nearly 100,000 people die from them. The cost to treat them can reach $27.5 billion.

"We think it is a good thing for Medicare to use its clout to try to put pressure on hospitals to do a better job of preventing infections," Consumers Union spokesman Michael McCauley said.

At LMH, Vice President of Clinical Services Karen Shumate said some of the conditions on the list - such as using the wrong blood type - are a rare occurrence. And, many times when the hospital is in the wrong, Shumate said, the hospital picks up the tab.

"We don't charge now if we feel like we caused or contributed to a condition," she said.

The biggest result of the rules, Shumate said, will be that hospitals need to make sure they document all of the patient's conditions before admission. And more lab tests might be required for incoming patients.

Because hospital stays can be short, Shumate said, it can be hard to figure out where infections originated once a patient leaves.

McCulloch has similar worries, noting that KU Hospital accepts patients from other hospitals and could have difficulty tracking down just where an infection was acquired.

And Shumate said some of the conditions, such as bedsores, could occur to highly prone patients regardless of the precautions taken by the hospitals.

McCulloch points to KU Hospital's burn center - the only one in the region - and said its patients are much more vulnerable to infections.

"We will put our infection rate against anyone in the country, but nobody is at zero just because of the type of business you are in and the unpredictability," McCulloch said.

Comments

Richard Heckler 7 years, 4 months ago

*It's time for universal Healthcare

  • Bringing all medical care under one umbrella instead of many different programs and over 300 insurance corporations(CEO salaries) reduces mountains of administrative debacles and tons upon tons of forms. *The United States has the most bureaucratic health care system in the world. Over 24% of every health care dollar goes to paperwork, overhead, CEO salaries, profits, and other non-clinical costs. Because the U.S. does not have a system that serves everyone and instead has over 1,500 different insurance plans, each with their own marketing, paperwork, enrollment, premiums, rules, and regulations, our insurance system is both extremely complex and fragmented. The Medicare program operates with just 3% overhead, compared to 15% to 25% overhead at a typical HMO.

It is not necessary to have a huge bureaucracy to decide who gets care and what care they get, if and when everyone is covered and has the same comprehensive benefits. With a universal health care system we would be able to cut our bureaucratic burden in half and save nearly $150 billion per year.

Richard Heckler 7 years, 4 months ago

Is national health insurance "socialized medicine"?

No. Socialized medicine is a system in which doctors and hospitals work for the government and draw salaries from the government. Doctors in the Veterans Administration and the Armed Services are paid this way. Examples also exist in Great Britain and Spain. But in most European countries, Canada, Australia and Japan they have socialized financing, or socialized health insurance, not socialized medicine. The government pays for care that is delivered in the private (mostly not-for-profit) sector. This is similar to how Medicare works in this country. Doctors are in private practice and are paid on a fee-for-service basis from government funds. The government does not own or manage their medical practices or hospitals.

The term socialized medicine is often used to conjure images of government bureaucratic interference in medical care. That does not describe what happens in countries with national health insurance. It does describe the interference by insurance company bureaucrats in our health system.

toefungus 7 years, 4 months ago

Medical care is so broken by all the greed.

Richard Heckler 7 years, 4 months ago

*64% of healthcare dollars are covered by tax dollars now. Gov't employees(city,state,fed),medicare,medicaid,military,veterans,social security,SRS,public schools etc.etc.

Currently, about 64% of our health care system is financed by public money: federal and state taxes, property taxes and tax subsidies. These funds pay for Medicare, Medicaid, the VA, coverage for public employees (including teachers), elected officials, military personnel, etc. There are also hefty tax subsidies to employers to help pay for their employees' health insurance. About 17% of heath care is financed by all of us individually through out-of-pocket payments, such as co-pays, deductibles, the uninsured paying directly for care, people paying privately for premiums, etc. Private employers only pay 19% of health care costs. In all, it is a very "regressive" way to finance health care, in that the poor pay a much higher percentage of their income for health care than higher income individuals do.

A universal public system would be financed this way: The public financing already funneled to Medicare and Medicaid would be retained. The difference, or the gap between current public funding and what we would need for a universal health care system, would be financed by a payroll tax on employers (about 7%) and an income tax on individuals (about 2%). The payroll tax would replace all other employer expenses for employees' health care. The income tax would take the place of all current insurance premiums, co-pays, deductibles, and any and all other out of pocket payments. For the vast majority of people a 2% income tax is less than what they now pay for insurance premiums and in out-of-pocket payments such as co-pays and deductibles, particularly for anyone who has had a serious illness or has a family member with a serious illness. It is also a fair and sustainable contribution. Currently, over 56 million people have no insurance and thousands of people with insurance are bankrupted when they have an accident or illness. Employers who currently offer no health insurance would pay more, but they would receive health insurance for the same low rate as larger firms. Many small employers have to pay 25% or more of payroll now for health insurance so they end up not having insurance at all. For large employers, a payroll tax in the 7% range would mean they would pay less than they currently do (about 8.5%). No employer, moreover, would hold a competitive advantage over another because his cost of business did not include health care. And health insurance would disappear from the bargaining table between employers and employees.

Another consideration is that everyone would have the same comprehensive health coverage, including all medical, hospital, eye care, dental care, long-term care, and mental health services. Currently, many people and businesses are paying huge premiums for insurance that is almost worthless if they were to have a serious illness.

warthog 7 years, 4 months ago

And, pray tell, why shouldn't the hospital be responsible for paying for its own mistakes, whether it be an infection that has been passed on to a patient or if it is a result of surgical incompetence? It is not the patient's responsibilty, nor should it be paid for by insurance. The whole medical field is getting to be absurd. Maybe it would be wiser to just save the money for needed for medical expenses to pay for a really nice funeral. Hospitals need to evaluate mistakes and learn from them and prevent them. If hospitals are doing their jobs, they don't have to worry about passing on costs to anyone.

Richard Heckler 7 years, 4 months ago

Free healthcare is not on the table. Never has been which makes that term misinformation. The coverage being discussed is paid for by most every adult in the USA.

Why shouldn't tax dollars cover medical coverage for all all instead of only those covered under federal programs including your elected officials who stand by their campaign money providers?

On the Wisconsin issue what we have is an opinion without a name attached which means that opinion could have been written by a HMO and/or insurance provider or maybe a stockholder. The character assassination forces come out when this matter is brought up. Their negative opinions have no substance. They are the primary source of misinformation and scary stories.

It is earth shattering to realize how many tax dollars currently go to for profit insurance providers knowing that money, plus USA military medical expenditures,VA medical expenditures,plus medicare,plus medicaid,plus other Social Security medical expenditures would likely cover the lions share of universal healthcare without blinking an eye. Pool the resources, reduce the bureaucratic nonsense created by so many different heathcare programs bring all of it under one umbrella such as medicare which has a history of being one of the most efficiently run government systems on the USA planet...bingo we've got it. Using Medicare prevents reinvention of the wheel.

Millions of USA jobs have gone to countries providing universal healthcare.

packrat 7 years, 4 months ago

The title for this article should be Government Health Insurance Rations Care.

matahari 7 years, 4 months ago

I think one of the reasons hospitals may think it's better to try and pay for mistakes (if the mistake can be proven) Is they don't want to be sued...even tho statistcs say most people will settle out of court since it oftentimes takes years to get your full entitlement. It's a shame they are passing this law, and watch, always right before a president leaves office the pass a bunch of stupid laws before they leave~laws that would never be passed if congress had the time to review/dispute them~

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