VIEWPOINT   THE CONSUMERS UNION PERSPECTIVE

Hospitals will have to pay for their mistakes

In 2004, the very hospitals where Dorothy Etheridge picked up infections and a bedsore were reimbursed by Medicare for the extra care she needed to recover from them. Etheridge, 73, a retired mental-health-care worker from New Hampshire, had a diagnosis of treatable lung cancer. The bed sore and infections added to her suffering and required significant hospital care in the last year of her life.

Consumers Union estimates that more than 2.4 million Americans suffer each year from an error or infection that occurs while they’re in the hospital for something else. Medicare, private insurers, or the patients are typically billed for the additional care they need to recover from hospital mistakes.

That’s about to change for the more than 40 million Medicare enrollees. Congress passed a law requiring the Centers for Medicare & Medicaid Services to start identifying preventable “hospital-acquired conditions” for which Medicare would no longer pay. The idea is to push hospitals to improve care by making them foot the bill when they err.

Medicare has listed eight preventable conditions for which it will not reimburse hospitals after Oct. 1, 2008, and is proposing nine more conditions to be added in 2009. The effects could widen as private insurers and state-funded health insurance programs begin to follow Medicare’s lead.

Some of the eight have been dubbed “never events” because they should never happen. They include leaving sponges or implements in a patient after surgery and giving the wrong type of blood. Several hospital-acquired infections are also on the list. In 2007, almost 500,000 hospitalized Medicare patients were hurt by the eight preventable events.

While the new rule bars hospitals from passing the bill on to the patient, it addresses only charges accrued in the initial hospital stay. But patients might need continuing treatment that adds up to a bundle. Consumers Union has asked Medicare to clarify that patients who are harmed by these preventable conditions will not be billed for any of the additional care they need.