Top ten issues in hospital medicine for 2007, issue 6: Medicare, CMS and hospital “mistakes”

This year the Centers for Medicare and Medicaid Services (CMS) revamped the prospective payment system and diagnosis related groups (DRGs). Among other provisions starting in October of 2008 (and this is the part that sparked the most controversy) when certain adverse events and conditions occur in the hospital (or aren’t documented to be present on admission) they can no longer be coded to enhance the DRG payment.

The language of the CMS regs implied that events such as hospital falls and hospital acquired decubitus ulcers were avoidable mistakes. Worse, the popular media simplistically spun the new regulations as “Medicare no longer paying for mistakes.” I wrote a series of posts (here, here and here) about unintended consequences and why the newspaper spin was wrong. The short version of my remarks is that a) Medicare hasn’t really paid for the care patients actually received, irrespective of “mistakes”, since 1984 and b) most falls, decubitus ulcers and many infections acquired in the hospital are not the result of mistakes.