Medicare Begins its “Never Pay” Category

Medicare recently came out with its “Never Pay” guidelines. The presumed motivation is the exponentially rising cost of medical care over the years that payers cannot sustain. The largest payer in the world is the U.S. Government in the form of Medicare payments. In an effort to reduce costs, Medicare has been steadily dinging reimbursements to physicians and hospitals in every medical specialty.

One easy target has been finding big ticket items that the public might support as charges that should not be paid to hospitals. Examples of these would be complications for surgery or medical errors. The thinking is that if a patient dies during surgery (presumably due to the surgery), then the surgeon and the hospital should not be paid for the surgery or hospitalization. This type of thinking has extended to create a philosophy that Medicare should not pay for “preventable” complications or morbidities. Examples of this would include post-operative infections or complications in the hospital.

Here is the list of six items that Medicare will no longer pay for:

• Pressure ulcers
• Staphylococcus aureus bloodstream infections/septicemia
• Catheter-associated urinary tract infections
• Objects left in patient during surgery
• Air embolisms
• Blood incompatibility

I’m going to comment on each of these in my next post, but suffice it to say that this is a perfect example of what works in theory does not work in practice. It is obvious that the committee that put this list together is not composed of physicians who know anything about medicine.