Clean house on healthcare-acquired conditions


In 2011 the Patient Protection and Affordable Care Act will stop federal Medicaid payments to states for services related to healthcare-acquired conditions, according to the Kaiser Family Foundation's handy health reform timeline. (Lost in the wilderness, a Bowie knife may be your tool for survival, but in the land of healthcare reform, it's an accurate timeline!)

No hospital executive needs me to tell them how to connect the inevitable dots: State Medicaid programs will soon join Medicare and many private insurers and no longer pay for healthcare-acquired conditions and corresponding services. In fact, bill AB 542 is currently winding its way through the California Legislature to end state Medi-Cal payments for mistakes by healthcare providers, reports California Watch.

The California Hospital Association basically supports the state bill--and who wouldn't? It makes sense that no one should be paid for leaving a sponge in a hapless patient or letting a bed-ridden patient develop pressure ulcers that require months or years of subsequent care.

However, if a recent exposé on Las Vegas hospitals is in any way indicative of what's occurring at other hospitals across the country, hospital management could be in for a rude awakening once healthcare payers across the board begin to concentrate on weeding out payments for healthcare-acquired conditions. In 2008 and 2009, patients at 13 Las Vegas hospitals "suffered preventable injuries, life-threatening infections or other harm 969 times during their stays," reports the Las Vegas Sun. That equates to about one injury per day for two years. And yes, that's for 13 hospitals and 425,000 inpatient visits.

But the 969 errors ran the gamut, including "21 cases in which hospital patients accidentally had foreign objects left in their bodies after surgery--eight at University Medical Center, seven at Sunrise Hospital & Medical Center, three at Valley Hospital Medical Center, two at Southern Hills Hospital & Medical Center and one at Summerlin Hospital Medical Center," says the Sun. That may not amount to much in terms of overall payments from Medicare, Medicaid or private insurers, but if you put aside the moral implications of the errors and add in the potential litigation costs as well, hospitals appear to be facing a quickly ticking time bomb when it comes to healthcare-acquired conditions. - Caralyn

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