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Hospital Surgical Mistakes Not Covered by Medicare
Starting in October 2008, Medicare, the government insurance program for the elderly and disabled, will no longer pay for the costs associated with correcting some surgical errors. That means that the government will not pay for the cost the hospital incurred when a surgeon left a medical instrument inside the patient following surgery. The government implemented a new program that withholds payments from hospitals that want to bill Medicare for the costs of correcting medical mistakes
There have been 10 conditions related to medical errors that Medicare considers “reasonably preventable,” which the government insurance program will not cover. The conditions are as follows:
• Foreign object, such as a surgical tool or sponge, left in the patient’s body after surgery
• Blood transfusion that was incompatible
• Pressure ulcers
• Air embolism
• Falls and trauma
• Urinary-tract infection from a catheter
• Vascular infection from a catheter
• Poor glycemic control
• Surgical infections from coronary bypass, orthopedic or bariatric surgeries
• Pulmonary embolism
It is important to note that these conditions do not include “never events,” which are events that should never occur in hospitals, such as removing the wrong limb or performing the wrong procedure on a patient. Medicare considers these 10 “reasonably preventable” conditions to be the result of poor hospital care. Patients will also not be required to pay, because hospitals will be responsible for covering the costs. Blue Cross and Blue Shield of Florida and Humana are following Medicare’s example, which will hopefully improve the quality of care and lower costs.
These changes come after Medicare’s initiative to obtain information and publicly report how well hospitals perform on dozens of measures. Medicare’s public reporting has made hospitals more aware of how they rank compared to other hospitals.
Officials at Medicare do not expect to save a huge amount of money with this new program, maybe an estimated $21 million of the $110 billion spent on in-patient hospital care annually. However, Medicare officials do believe that their decision will pressure hospitals to improve quality, therefore producing a higher savings by reducing unnecessary treatments resulting from medical mistakes.
Bill Donelan, vice president for medical administration at the University of Miami stated that “this is really a natural progression of using whatever levers are available to encourage continuing efforts of quality and safety. Medicare is working to reward good performance with incremental payment. This is the old carrot-and-stick analysis.”
If you or a loved one has been injured by a surgical mistake, you should seek legal advice. Contact the law offices of Lilly, O'Toole & Brown, LLP at (863) 683-1111 to speak with a Florida medical malpractice attorney.
Lilly, O'Toole & Brown, LLP
Lakeland Office: (863) 683-1111
Bartow Office: (863) 533-5525
Sebring Office: (863) 471-0003
Lake Wales Office: (863) 676-1991
Haines City Office: (863) 422-1282
Wauchula Office: (863) 767-1111
Winter Haven Office (863) 294-8100
Also providing legal assistance to clients from:
Wauchula, Lake Placid, Avon Park, Plant City, Brandon, and Valrico, Florida.
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Lakeland Office
800 S. Florida Ave.
Lakeland, FL 33801
Phone: (863) 683-1111
Fax: (863) 683-0915
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Sebring Office
2154 Lakeview Drive
Sebring, FL 33870
Phone: (863) 471-0003
Fax: (863) 471-2034
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Bartow Office
310 E. Main Street
Bartow, FL 33830
Phone: (863) 533-5525
Fax: (863) 533-0505
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Lake Wales Office
815 S.R. 60 East
Lake Wales, FL 33853
Phone: (863) 676-1991
Fax: (863) 676-3873
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Winter Haven
70 Fourth Street N.W.
Winter Haven, FL 33881
Phone: (863) 294-8100
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