Medicare has announced that it will no longer pay hospitals for the costs of treating injuries and illnesses resulting from errors made by the hospital, according to Robert Pear of the New York Times. “If a patient goes into the hospital with pneumonia, we don’t want them to leave with a broken arm,” said Herb B. Kuhn, acting deputy administrator of the Centers for Medicare and Medicaid Services.

“Under the new rules, to be published next week, Medicare will not pay hospitals for the costs of treating certain ‘conditions that could reasonably have been prevented.’”

Among the conditions that will be affected are falls, mediastinitis (an infection that can develop after heart surgery), urinary tract infections that result from improper use of catheters, pressure ulcers, and vascular infections that result from improper use of catheters.

In addition, Medicare says it will not pay for the treatment of “serious preventable events” like falls, leaving a sponge or other object in a patient during surgery and providing a patient with incompatible blood or blood products.”

And if you’re worried that the hospitals will bill the patient for charges that Medicare refuses to pay, the rules make that forbidden. “The hospital cannot bill the beneficiary for any charges associated with the hospital-acquired complication,” the final rules say.

Consumer advocates reportedly have been urging Medicare to adopt these rules for twenty years. The reason being that if hospitals know that they won’t get paid for making you sick, they will take precautions to prevent these illnesses and accidents.

The rules don't take effect until October 2008.

The Centers for Disease Control and Prevention estimates that “patients develop 1.7 million infections in hospitals each year, and it says those infections cause or contribute to the death of 99,000 people a year — about 270 a day.”

“Hundreds of thousands of people suffer needlessly from preventable hospital infections and medical errors every year,” said Lisa A. McGiffert of Consumer’s Union. “Medicare is using its clout to improve care and keep patients safe. It’s forcing hospitals to face this problem in a way they never have before.”

The change in the rules is coming too late for Margaret M. O’Neill(pictured here with her daughter Eileen O’Neill-Pardo). In 2004, Margaret died of an infection that developed during intestinal surgery at a Seattle hospital.

“The operation — to remove scar tissue — was successful, but the patient died,” Eileen said. “The hospital staff did not take steps to control the infection, which took over her body. My mother died less than a week after the operation.”



Studies have shown that well-established infection-control practices, "like covering doctors and patients from head to toe with sterile gowns and sheets while the catheters were inserted, can greatly reduce the incidence of hospital-acquired infections."

Medicare absolutely made the right call in putting pressure ulcers on the list of preventable conditions. Studies have repeatedly showed that hospital-acquired pressure ulcers can be virtually eliminated if correct precautions are taken by the hospital.

Presumably the rules also apply to nursing homes. If so, then Medicare will refuse to pay nursing homes for treatment of pressure ulcers that are acquired in the nursing home, or where the nursing home lets the existing pressure ulcers get worse. About time!

There are many unanswered questions, but one thing is for sure. Hospitals will begin to do things differently if they are not paid for their mistakes. The new Medicare rules will also provide patients and their lawyers with a formidable weapon to use in a neglect lawsuit against the hospital or nursing home. If Medicare deems that the expense of treating the illness or injury was preventable, that is powerful evidence that the hospital or nursing home was negligent in letting the illness or injury develop.

To read Robert Pear's article, click here.

Felicia Curran
www.ElderAdvocacyLaw.com

Bankruptcies are increasing faster among Americans 55 and over than in any other age group, according to a recent article in the Herald Tribune. People 65 and over accounted for nearly 5 percent of bankruptcy filings in 2002 -- nearly double the 2.5 percent figure from 1994, a report published in the American Bankruptcy Institute Journal found.

More older people are carrying more debt, from mortgages to home equity loans and even credit card bills, than ever before. The article quotes analysts who say the trend signals underlying problems with the country's health care, economic and elder care systems, which have implications for the next generation.

"If you have older Americans who are spending much of their money and savings for health care and general cost of living, they're not able to pass on that wealth to subsequent generations," said Deborah Thorne, an Ohio University professor who co-wrote a major 2001 study on aging and bankruptcy and is working on another.

A 2001 research study tracked a rise in the total number of older people filing for bankruptcy in the 1990s and a doubling since 1994 in the rate at which older people filed.

Reports by the National Consumer Law Center, the nonprofit group Demos, AARP and others have tracked the bankruptcy increase and potential causes in a series of reports.

They have noted that incomes for many older Americans have been largely stagnant -- the median income for older households is less than $25,000 -- while living expenses have escalated.

"For many retirees, Social Security and pension income are simply no longer sufficient to meet day-to-day needs," the National Consumer Law Center stated in a July 2006 report. "In rapidly increasing numbers, elders are using credit to pay for necessities like groceries, drugs and urgent house repairs."

A case in point is Brenda Broadbent, pictured above, who filed for bankruptcy at 59, a time she expected to be planning her retirement. She was self-employed as a real estate agent, and could not afford health insurance. A heart attack, which required bypass surgery, left her buried by nearly $100,000 in medical bills. She lost her house, her car and any sense of control. "It was a very dark time in my life," said Brenda.

"I was trying to get my ducks in a row" to retire at 65, she said. Now, "I'll be working probably until they put me in a pine box," she added.

Unable to work after her surgery, Brenda could not satisfy the mortgage, car and utility bills, or the thousands of dollars in charges for house repairs and new furnishings. Impaired by post-surgery memory loss, she could not return to handling real estate transactions. She is working only part-time now.

"My phone rang every six minutes, from 8 in the morning until 9 at night," Brenda said of the calls from creditors. "I knew I had to do something."

She filed for bankruptcy in the spring of 2004. Though much of the debt was eliminated over the next few months, she was hardly relieved. "I was devastated. I didn't want to go out of my house," she said. "I felt the whole world knew. You feel like you've committed a crime."

Carrying debt is a bigger danger for the older population because they have fewer years to recover and are more likely to be disabled, face age discrimination and confront other problems that preclude working to pay off bills.

Younger people can take second jobs or put more family members to work, but older people don’t have that option. Brenda is still applying for jobs. More than once, she has left a job interview certain that she would receive an offer, only to hear nothing. One prospective employer, she says, asked in a job interview about her "five-year plan."

"I almost laughed in his face," she said. "I should have said, 'To be alive and well.'"

President Bush and the Republicans foolishly say the solution is for people like Brenda to set aside money for health insurance. Brenda might as well try saving for a Lamborghini. For many older Americans the cost of healthcare insurance is out of their reach.

Healthcare is a right, not a privilege. Instead of protecting our elders, we protect the insurance industry's strangle-hold on healthcare insurance. Do your part to make 2008 the election year in which we take control of our healthcare system and guarantee health insurance for everyone.

To read the excellent article, click here.

Felicia Curran
www.ElderAdvocacyLaw.com

Are you interested in proposed laws affecting Medicare? The National Committee to Preserve Social Security and Medicare has an excellent blog, www.entitledtoknow.blogspot.com that is regularly updated regarding proposed laws affecting Medicare and Social Security. There are oodles of information on the blog, from the last month, relating to Medicare Advantage plans, the marketing tactics used by insurance companies pushing those plans, and the cost of these plans.


Felicia Curran
www.ElderAdvocacyLaw.com

In a few days Democrats in the U.S. House of Representatives will introduce a bill which, if enacted, will provide important protections for Medicare recipients. The Children’s Health and Medicare Protection Act started out as a bill designed to expand insurance coverage nationwide for low-income children. Republicans in the Senate Finance Committee voted last week with Democrats to approve that bill which would provide financing for health insurance for all low-income children by raising cigarette taxes.

Democrats have announced that they will attempt to push through an expanded version of the bill, which would reverse the free ride that private Medicare plans currently enjoy at elder tax payers' expense. In 1997, the Republican Congress passed a law allowing seniors to replace traditional Medicare health coverage with enrollment in a fee-for-service health insurance plan. Congress actually pays these private plans - called Medicare Advantage Plans – huge subsidies, paying 19% more on average per senior than for the same services under traditional Medicare. No wonder Medicare is scheduled to go broke!

Not only do these plans get higher reimbursement rates from the government than services provided under traditional Medicare, these Medicare Advantage plans often have much larger co-pays for hospital stays, home health aides, nursing home stays and prescription drug plans than traditional Medicare does. Seniors often don’t realize that there are higher co-pays until they get the hospital or other bill, and by then it is too late. (See Elder Advocacy Blog: "Government Subsidizes Insurance Companies Who Push Private Fee-For-Service Medicare Plans On Unwary Seniors" May 8, 2007).

The bill proposed by Democrats would prohibit private Medicare plans from charging higher co-pays than traditional Medicare, and would give State insurance commissioners power to regulate marketing of these private plans to Medicare recipients. The bill also contains provisions to eliminate the outrageous government subsidies given to these private plans.

To gain the support of physicians, Democrats have shrewdly added provisions that would block cuts in Medicare payments to physicians. That was evidently enough to prompt the American Medical Association to join with AARP in endorsing the bill. Olay!

Bush was quoted as saying that the bill is a step "down the path to government-run health care for every American." All I can say is, "I HOPE SO."

Needless to say, insurance companies are up in arms against the bill. The insurance and tobacco industries are pulling out all stops to block this bill, and they know they can count on President Bush to veto it. These Medicare Advantage plans have received a lot of well-deserved negative publicity, however, and Republicans will be under pressure to vote for the bill.

Do your part, and contact your Representatives in Congress and the Senate and urge them to support the Children’s Health and Medicare Protection Act.

The information in this entry came from a July 23, 2007 front page article of the New York Times. To read the article, click here.

Click here for email addresses and phone numbers for your representatives.


Felicia Curran
www.ElderAdvocacyLaw.com

The U.S. General Accountability Office recently filed a report where it reviewed federal oversight of a group of 63 nursing homes nationwide that have a history of repeatedly harming nursing home residents. In 1998 and 1999, GAO had issued reports reviewing the oversight exercised by the Centers for Medicare & Medicaid Services (CMS) over nursing homes. Those reports found that sanctions CMS imposed on bad nursing homes often did not take effect, because CMS had adopted a policy of giving nursing homes a “grace period” to correct deficiencies before sanctions would be imposed. The prior reports found a “yo-yo” pattern where the nursing homes would cycle into compliance just long enough to avoid the sanctions, and then revert to a pattern of serious violations - avoiding sanctions while continuing to harm residents.

In response to the GAO reports, CMS was supposed to adopt an “immediate sanctions” policy for nursing homes found to repeatedly harm residents. Did they? According to the current GAO report, the answer is “no.” The CMS “immediate sanctions” policy is in name only. More than half of the 63 homes that had serious violations that had harmed residents as of 1999 continued to have serious violations during 2000-2005.

GAO attributes the continuing yo-yo effect to CMS' lax enforcement policies, including failure to impose fines, delaying imposing fines, and levying fines in such small amounts that it is more profitable for the nursing homes to pay the fines (which averaged $350 to $500 per day) than it is for them to provide good care to nursing home residents. An example is:

“A significant medication error occurred when resident #8 was administered the wrong medication over a three day period. The resident experienced hypoglycemia and required hospitalization. Upon return from the hospital there was evidence of actual harm: a decline in the resident’s ability to perform activities of daily living.” The fine for this citation could have been anywhere from $1,000 to $10,000. CMS only fined the home $1,500.

GAO says that CMS terminated from Medicare or Medicaid reimbursement only 2 of the 63 bad homes. What incentive would a nursing home have to do things differently? These bad nursing homes are actually being paid by Medicare or Medicaid to provide the very care that CMS has determined merits a citation. The nursing homes can actually pay the fines with the money that they are receiving from Medicare for the resident’s care.

As long as the federal government makes it cheaper for nursing homes to violate the law than it is to comply, elderly residents will continue to be neglected by nursing homes. For the big corporations that own the nursing homes, it’s just more cost-effective to neglect the residents and pay the paltry fine if they get caught.

And, if you’d like to know the names of the 63 “repeat offender” “yo-yo" nursing homes studied in the GAO report, you’re out of luck: GAO won’t disclose their names. You or your parents could be living in one of these homes (which were in Texas, California, Michigan and Pennsylvania).

To read the GAO report, click here.

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Felicia Curran
www.ElderAdvocacyLaw.com