Medicare Begins its “Never Pay” Category




Law_Politics2.jpgMedicare 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.

  • You have been tagged for The Personal Development List. (See my site for details), I would love to have you participate.

  • Pingback: A Patient is Not a Consumer | GNIF Brain Blogger()

  • Susan

    I just started reading your blog and am amazed that there aren’t more comments about this issue. Medicare is a huge and complex system that I know nothing about, personally or professionally. However, I have felt guilty about this long enough and this never pay category issue will be my wake up call. thanks for bringing it to my attention- what can be done? How do we learn more?

  • Pingback: Health Wonk Review | The Doctor Is In()

  • D Wells

    This is silly. Physicians should be paid (or not) strictly on the basis of whether or not I like them. Anything else is unscientific.

  • sarah

    this is kinda scary. what medicare does, insurance companies are sure to follow. i am predicting that medicare and insurance companies are going to get ever more “picky” about what they will not pay for. I feel like these kind of restrictions will lead to dishonesty in the medical community and the patient will undoubtedly suffer.

  • Beth Richards

    I work in medical insurance, and I can tell you all out there, this makes the case for not supporting socialized medicine. Medicare is funded by the sweat of the M.D.’s who treat medicare and medicaid pts. The reimbursement is very low, and each year they cut payment. Do you want politicians who are not qualified to make medical decision for you? Think about it! I ask you to name one social program the government has run efficiently. Do not fall for socialized medicine! Spread the word!

  • Nice post. Do you like britney ? You can find Britney’s new Songs and MTVs at
    Britney Times

JC, MD

Dr. JC is a medical doctor who has a passion for health promotion and education.
See All Posts By The Author

Do not miss out ever again. Subscribe to get our newsletter delivered to your inbox a few times a month.