Hospitals on edge about new Medicare rules

Anyone who's rented a car knows the drill: Walk around and check out those dings and scratches now so you don't get stuck paying for them later.

Now, local hospitals are doing the same thing with their patients. The practice comes in response to new Medicare rules that could cost them thousands of dollars for certain problems that occur on their watch.

Beginning Oct. 1, the federal Medicare program will quit reimbursing hospitals for patients who suffer from bedsores, falls, or urinary-tract infections from catheters as a result of their hospital stays. Insurance companies are considering following Medicare's lead.

The changes have put hospital doctors on the defensive, because something like an unnoticed or undocumented bedsore could leave the patient's treatment uncompensated if it were discovered after admission. "Bottom line, if it's not charted, it didn't happen," said Chris Valentine, spokesman for Memorial Health System.

Nationally, there has been a push in recent years to curb hospital errors, which can range from egregious mistakes like amputating the wrong leg to understandable oversights like not turning a sickly patient enough times to prevent bedsores, or pressure ulcers.
But the changes in Medicare are the first to put a price tag on problems when they occur.

Local hospital officials at Memorial and Penrose-St. Francis Health Services support the idea, saying someone shouldn't have to pay for a mistake the hospital made. But they also fear that in practice it may penalize them for things beyond their control. Dr. Jeff Oram-Smith, chief medical officer for Penrose-St. Francis Health Services, said some of these problems occur even when everything is done right.

In rehabilitation, for example, patients are pushed to their limits as part of their recovery, said Linda Larkin, Memorial Health System's risk manager, and sometimes they fall. Jennifer Tatro, Memorial's director of hospital quality, said some patients are so sickly and unstable they can't be turned frequently.

So far, a dozen conditions are on the Medicare no-pay list, Larkin said. That could expand to more than two dozen over time.
Health care providers speculate the changes could lead to guarded medical practice, such as patients getting tested for urinary-tract infections upon admission even when there are no symptoms.

Penrose and Memorial said it's too early to tell how much money they stand to lose, but hope the efforts to curb errors will, quite literally, pay off.