Preventable Surgical Mistakes Will No Longer Be Paid by Medicare

Medicare, the federal insurance program for the disabled and elderly, will no longer pay for surgical mistakes, such as leaving a scalpel inside a patient.  As of October 2008, Medicare will not reimburse hospitals for costs associated with correcting surgical errors.  The federal government implemented a new program that withholds some payments from hospitals that want to bill Medicare for these costs.

There are 10 “reasonably” preventable conditions that Medicare has listed as situations in which it will not make payments to the hospital.  These conditions do not include “never events” which are occurrences that should not have happened, such as operating on the wrong patient or removing the wrong limb.   The government does not believe that it should have to bear the costs incurred by the hospital for correcting its own mistakes.  Examples include, a second surgery to remove an object or treating a urinary tract infection caused by a catheter.  The complete list of conditions no longer covered is as follows:

• Foreign object left inside patient after surgery
• Air embolism
• Blood transfusion that was incompatible
• Pressure ulcers
• Falls and trauma
• Urinary-tract infection from a catheter
• Vascular infection from a catheter
• Poor glycemic control
• Surgical infections
• Deep vein thrombosis/pulmonary embolism from orthopedic care

The payment changes follow Medicare’s initiative to obtain and publicly report how well hospitals rank on numerous measures.  Medicare has created a website where it posts this information, which includes such data as heart failure rates and heart attack procedures.  Hospitals are more aware of how they rank compared to other medical facilities.  Medicare’s objective is to improve health-care quality through a system that rewards good practices.

Some insurance companies are following suit by creating their own policies regarding surgical errors.  Anthem Blue Cross and Blue Shield, Virginia’s largest private insurer, has created a new policy that would force state hospitals to pay the costs for certain preventable surgical errors.  The list is not as extensive as Medicare’s, but includes four core surgical mistakes in which it will not pay.  These four medical errors include the following:

• Operating on the wrong body part
• Performing the wrong procedure on a patient
• Leaving medical supplies inside a patient
• Operating on the wrong patient

Dr. Jay Schukman, the lead director for Anthem in Virginia, stated “It was our intent to put these into our contracts to raise the profile on patient safety.  That’s the main issue.”

If you have been injured by a surgical mistake, contact the Virginia medical malpractice attorneys at Tavss Fletcher at (757) 625-1214.