WASHINGTON, D.C. - In an unprecedented cost-cutting move, Bush administration officials say that Medicare will no longer pay the extra cost of treating preventable errors, injuries and infections that occur in hospitals, a new policy that the administration says could save lives and millions of dollars.

The Bush administration estimates the new policy will save Medicare $20 million a year. But other experts say the savings could be substantially greater.

Private insurers are considering similar changes, which they said could multiply the savings and benefits for patients.
The new policy — one of several federal initiatives to improve care purchased by Medicare, at a cost of more than $400 billion a year — is sending ripples through the nursing community.

Privately, nurses are concerned that they will be the scapegoat for the errors.  Many feel that they will get blamed for mistakes caused by overwork and exhaustion, fueled by the nursing shortage and in some instances, mandatory overtime.

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 bedsores, or pressure ulcers; injuries caused by falls, and infections resulting from the prolonged use of catheters in blood vessels or the bladder.

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

It also raises the possibility of changes in medical practice as doctors adhere more closely to clinical guidelines and hospitals perform more tests to assess the condition of patients at the time of admission.

Nurses worry that consumers will have to absorb the costs of these unnecessary tests because Medicare generally pays a flat amount for each case.  Nurses believe that it will be the consumer who will eventually pay for the loss of the Medicare revenues.

And consumer groups welcome the change.  The CDC 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.

Intravenous catheters are widely used to provide hospital patients with medications, nutrition and fluids, but complications are relatively common.

And while hospital executives are endorsing the goal of patient safety in public, they are privately saying said the policy will require them to collect large amounts of data that they do not have now.

Sally Newburg, a Staff RN in Chicago commented that, "Bush is milking Medicare while giving the appearance that he's improving care and keeping patients safe. He's going to cost the hospitals a fortune at a time when they simply can't afford it."

Another called it, "Just another way for Bush to pay for his war."

Nurses generally agree with infection-control specialists that this problem is serious because hospital infections hurt patients and cost lives.  But many saw the lack of adequate staffing as a major cause that this wouldn't remedy.  "And with the loss of these Medicare dollars, they'll be at an even greater loss to pay for additional staff."

Nurses agree that some of the conditions cited by Medicare officials were not entirely preventable. Commenting on the proposed rules in June, they note that “Certain patients, including those at the end of life, may be exceptionally prone to developing pressure ulcers, despite receiving appropriate care.”

In most states, hospital records do not show whether a particular condition developed before or after a patient entered the hospital. Under the new rules, hospitals will have to perform more laboratory tests to determine, for example, if patients have urinary tract infections at the time of admission. 

A 120-hour-a-week night shift RN commented that the rules would encourage unnecessary testing by hospitals eager to show that infections were already present at the time of admission and did not develop in the hospital. Moreover, she said that serious, costly infections can occur even when doctors and nurses take all the recommended precautions.

The common consensus among nurses was that Bush's plan would once again hurt the middle class and a new wave of Americans would be unable to afford health insurance.

"If 40% of the American people are without health insurance now", said Sallie, "just wait
for it to hit 42% from Bush's actions next week. Someone's got to pay for this, and you know who."