Kentucky

The list of "PREVENTABLE INJURIES' not to be paid by Medicaid beginning 10/1/08 are:

Urinary-tract infections from catheters.
Bloodstream infections from catheters.
Falls.
Bedsores or pressure ulcers.
Objects left in surgery patients.
Blood incompatibility.
Mediastinitis, a post-heart-surgery infection.
Air embolism, an air bubble in a blood vessel.

For the Courier Journal story from 2/19/2008 with a Lauran Neergaard byline from Washington DC.  Please read the story in detail so you do not think there will be a lack of care but simply a refusal to pay for medical mistakes. 

The unanswered questions originally posed some time ago are what will non-governmental health insurers do (follow suit)?  what impact will this have on the manufactured medical insurance crisis and lawsuits?  will the federal government's definition that the medical procedures and thus the underlying condition was preventable negate the need for an expert in medical negligence cases and/or an admissible fact and/or a fact to cross-examine the doctor or the hospital? 

And, the Medicaid preventable injuries list was not an issue in the broadcast on why

Presumably, a medical negligence suit based upon these eight preventable injuries would not fall under the umbrella of "frivolous lawsuits".  See, Appalachian News Express editorial entitled "With malpractice claims declining, insurers should be held accountable" busts the medical insurer's claims for higher premiums is not accurate;

Medicare is targeting hospital errors
Do-not-pay list takes effect Oct. 1


WASHINGTON -- It's a new way to push for patient safety: Don't pay hospitals when they make certain errors.

Medicare will start hitting hospitals where it hurts in October, and other insurers are hot on the trail.

That has the nation's hospitals exploring innovative programs to prevent injury and infection: Hand-washing spies. Surgical sponges that sound an alarm if left in the body. Even a room sterilizer that promises to wipe out bacteria on bed rails.

"Money talks," said Dr. Steven Gordon, infectious-disease chief at the Cleveland Clinic Foundation. "Every hospital CFO, this gets their attention."

And patients' first sign that something is changing may involve lessening of a big indignity: Today, one in four hospitalized patients gets a urinary catheter. Each year the tubes trigger more than half a million urinary-tract infections, the most common type of hospital-caused infection.

Yet many patients don't even need catheters -- they're an automatic precaution after certain surgeries -- and many who do, have them for days longer than necessary.

Why? The University of Michigan reported the first national study of catheter practices last month, finding that nearly half of hospitals don't even keep track of who gets one. Fewer than one in 10 hospitals does a daily check to see if the catheter is still needed, a proven infection-reducing system.

With those infections topping Medicare's do-not-pay list, Gordon said hospitals are already beginning to get more careful about who gets catheters, and to remove them sooner.

Even when a hospital makes a preventable error, it still can be paid for the extra treatment that patient requires as a result. Some errors can add $10,000 to $100,000 to the cost of a patient's stay.

Beginning Oct. 1, Medicare will no longer pay those extra-care costs for eight preventable hospital errors, including catheter-caused urinary-tract infections, injuries from falls, and leaving objects in the body after surgery. Nor can hospitals bill the injured patient for those extra costs.

Next year, Medicare will add three more errors to the no-pay list; ventilator-caused pneumonia and drug-resistant staph infections are top candidates.

Medicare, which insures about 44 million elderly and disabled people, estimates the move will save the government $190 million over five years.

It also led to changes elsewhere: Big insurance companies like Aetna are moving to make hospitals absorb the cost of serious errors. Last month Pennsylvania said it would follow Medicare's example and stop Medicaid payments, too. The American Hospital Association is urging members to voluntarily quit billing for treatment of serious errors, and hospitals in a number of states, from Minnesota to Vermont, have announced they will do so.

Many hospitals already were trying to improve patient safety for a bigger reason -- to prevent suffering and death -- and a question is whether making them literally pay for mistakes will spur greater improvements. But some novel attempts are under way:

A standard mop-and-bucket cleaning leaves bacteria in hospital rooms, especially on electronic equipment that janitors hesitate to touch. So the Wellmont Health System in Kingsport, Tenn., is testing a portable machine that sterilizes a closed room by spewing out vaporized hydrogen peroxide that reaches into every nook and cranny.

Steris Corp.'s VaproSure is proven to eliminate tough germs; it has long been used in sterile manufacturing facilities, and even helped clean buildings tainted in the 2001 anthrax attacks.

But doctors, nurses and others bring new germs into rooms every time they enter, raising the question of whether sterilizing between check-ins will really lead to fewer infections.

"There's no question they can sterilize a room," Wellmont's chief executive, Dr. Richard Salluzzo, said of the $180,000 machines. "Has it prevented infection? We don't have the answer to that yet."

He hopes to have enough data to tell by year's end.

Nurses count surgical sponges to make sure they're all out before a patient is sewn up, but every hospital occasionally misses some. In University of Michigan operating rooms, doctors are testing sponges tagged with bar code-like, radio-frequency chips. Wave a wand and a beep sounds if a sponge is still in the wound. Or nurses can drop used sponges into a "smart" bucket that counts how many are missing.

"We've had a long history in medicine of this problem continuing to occur no matter what kind of very careful steps we've devised," said Dr. Darrell Campbell, a well-known patient-safety specialist. "We want to get to zero."

In the University of Michigan's hospital halls, physician assistants are assigned to spy and tell if fellow workers wash hands both when entering and exiting patient rooms. Workers are better at remembering on the way in, but they don't want to carry germs back to the nurses' station or elevator buttons, either, Campbell notes. Some bugs can live on cool hospital surfaces for weeks.

There is some concern that the no-pay push could make hospitals try to hide certain errors, or just trade one problem for another. Pull a urinary catheter too soon, for example, and a fragile patient may fall going to the bathroom, said Michigan's Campbell.

"I don't know how much is really preventable," added the Cleveland Clinic's Gordon. "We want to chase zero, but we'll probably never get to zero."