Medicare payment revisions

  This week the Federal government announced a new plan to withold payment to medical providers for services that were necessitated by the providers' own negligence.    As a starting point, Medicare will no longer pay for the removal of surgical tools or sponges left in a patient; it won't reimburse for extra care given after the transfusion of incompatible blood or the injection of an air embolism.  Treatment for bedsores that develop in-hospital, hospital falls and certain nosocomial (hospital-acquired) infections also won't be covered.

        While the underlying logic of this strategy is unassailable (why should we pay more to the negligent entity that caused a problem?), it will be interesting to see what happens to candor as a result.  We have seen multiple examples over the years of medical charting that was shaded--or even changed--to obfuscate the cause of a complication.   For example, the Discharge Summary that we were provided after ordering a young woman's medical chart from a local hospital was later identified as a re-written substitute prepared after her torn jejunum was diagnosed during a subsequent admission:  the original damning Discharge Summary which identified the symptoms but failed to rule out the diagnosis was mailed to us anonymously, weeks later, under separate cover.

       Giving health care providers an additional financial incentive to obscure the actual cause of preventable complications may actually interfere with the identification, treatment and understanding of these problems.  The medical community has a long history of applauding the confidentiality of "peer review", where errors are investigated and disclosed, but only in secret procedures.  Some medical and legal authorities believe that this type of secrecy is just and is essential to proper medical care, so there is already a sense within the community that something less than full disclosure is reasonable and fair.  Under these new rules, it is likely that more families will be informed of the "preventable" nature of their complication because of Medicare resistance to payment, but it is also likely that some complications will be even more completely "buried" in the patient chart so that they won't disrupt timely payment. 

        It is also highly likely that some medical providers will order blanket tests on admission to ferret out any existing infection and that providers will order that more patients be restrained to avoid even a minimal risk of falling.  An acceptable risk from the standpoint of the patient's health may be less acceptable to some administrators if it implicates the accounting bottom line.