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Medicare against mistakes

THE FEDERAL government is using the enormous financial power of Medicare to penalize hospitals where patients are harmed by medical mistakes. The new policy may require refinement, but it puts US hospitals on notice that they have got to work harder to make sure patients do not suffer needless harm while under their care.

Acting upon instruction from Congress, the Centers for Medicare and Medicaid Services issued rules this month that, starting in October of 2008, Medicare will no longer pay extra for hospital care needed to remedy a mistake in eight specific areas. The hospital is prohibited from billing the patient for the difference. The hospital can seek a review of any disputed charge, but if Medicare administrators determine that the problem arose there, the hospital will have to absorb the cost.

News of the rule was first reported over the weekend, and the initial reaction was ambivalent. Few hospital administrators would object to picking up the cost for such unforgivable mistakes as leaving a sponge inside a patient or transfusing a patient with the wrong type of blood. But the new rule lists six other conditions, the most controversial among them being hospital-acquired infections. After all, a patient may have gotten infected before he or she was admitted.

It is well known in medical circles, however, that mistakes happen all the time in hospitals, with sometimes dire consequences -- infections being the most common. The Centers for Disease Control and Prevention estimates that patients develop 1.7 million infections a year in hospitals and that 99,000 die as a result. With a few exceptions, hospitals have traditionally been reluctant to release data on infection rates, let alone lay out a strategy to deal with the problem. Facing the loss of Medicare money should force them to act.

In Massachusetts, the first step is to make public the infection rates. The state Department of Public Health needs to move expeditiously to establish guidelines for uniform reporting so that hospitals can be compared accurately against each other.

Hospitals also need to make public the rate of other medical errors listed by the Medicare regulators, and lay out their strategies to prevent them. These include the number of times patients fall and the number of pressure ulcers, commonly called bedsores, caused by prolonged bed stays.

Before the Centers for Medicare and Medicaid make adjustments in their new rules, they need to be convinced that hospitals are doing their best to minimize the occurrence of these mistakes. The federal government, through Medicare, spent more than $185 billion on hospital care in 2006, and almost certainly more this year. None of this money should subsidize botched treatment.

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