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KAI RYSSDAL: Whether or not you’re of an age to qualify for Medicare coverage, this next story could still be of some interest to you. Medicare is set to publish some new rules this week coverning how it pays for hospital care. Or, perhaps, how it won’t pay.
Starting next year the government health program for seniors will pay providers more for treating sicker patients. But less if hospitals make mistakes that make patients sicker. Helen Palmer reports from the Marketplace Health Desk at WGBH, Medicare’s about the 800-pound gorilla of medical payers, which means other insurers will surely follow suit.
Helen Palmer: For too long Medicare’s just been the big daddy that pays the $400 billion-a-year bill.
Herb Kuhn: What we really want to do is become an active purchaser of care.
Herb Kuhn is Medicare’s acting deputy administrator. He says this payment reform is part of Medicare’s push towards quality care. Why should they pay for mistakes that should never happen?
Kuhn: Things like infections, urinary tract infections, and also what are the so-called never events, like objects left in the body during surgery.
Kuhn says evidence and practice show events like this are preventable, and this new rule uses the payment system to make sure eight specific bad outcomes are prevented. Consumer groups are cheering.
Robert Hayes of the Medicare Rights Center:
Robert Hayes: For the federal government to step in and say, “Whoa, we are going to put some heavy pressure on hospitals to start following the accepted practices that make better health care and better health care outcomes is a very positive thing.
Hayes warns there’s a risk hospitals will start aggressive testing when patients are admitted to prove that, say, an infection they developed there had some cause other than sloppy hospital practices. And the American Hospital Association’s Nancy Foster says the new Medicare payment rules may not actually make things better.
Nancy Foster: Not every complication is preventable.
Foster says, for example, falls that cause injury are on Medicare’s list of preventable events, but patients who are confused or have just had surgery may try to get out of bed and injure themselves — and there just aren’t enough nurses to watch every patient 24/7. Private plans haven’t decided yet when they’ll follow Medicare’s example, but Susan Pisano of the insurers lobby says it makes sense.
Susan Pisano: Paying the same for good quality as you pay for bad quality really provides the wrong incentives. The idea is that if you pay for quality, you will improve quality.
And of course, you’ll save cash too. Infection preventing moves like frequent hand washing and using sterile drapes are relatively cheap. And Medicare’s Herb Kuhn sees considerable savings.
Kuhn: We’re looking at savings of around $20 million per year.
And the rule tht will bring the savings also mandates that the extra costs can’t be passed on to patients.
In Boston, I’m Helen Palmer for Marketplace.
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