Beginning Oct. 1, Medicare no longer will pay those extra-care costs for eight preventable hospital errors, including catheter-caused urinary tract infections, injuries from falls, and leaving objects in the body after surgery. Nor can hospitals bill the injured patient for those extra costs.
Next year, Medicare will add three more errors to the no-pay list; ventilator-caused pneumonia and drug-resistant staph infections are top candidates.
Medicare, which insures about 44 million elderly and disabled people, estimates the move will save the government about $190 million over five years.
It also sparked a movement: Private insurance giants like Aetna are moving to make hospitals absorb the cost of serious errors. Pennsylvania last month said it would follow Medicare's example and stop Medicaid payments, too. The American Hospital Association is urging members to voluntarily quit billing for treatment of serious errors, and hospitals in a number of states, from Minnesota to Vermont, have announced they will.
Many hospitals already were trying to improve patient safety for a bigger reason — to prevent suffering and death — and a question is whether making them literally pay for mistakes will spur greater improvements. But some novel attempts are under way:
— A standard mop-and-bucket cleaning leaves bacteria in hospital rooms, especially on electronic equipment that janitors hesitate to touch. So the Wellmont Health System in Kingsport, Tenn., is testing a portable machine that sterilizes a closed room by spewing out vaporized hydrogen peroxide that reach into every nook and cranny.
STERIS Corp.'s VaproSure is proven to eliminate tough germs; it has long been used in sterile manufacturing facilities, and even helped clean buildings tainted in the 2001 anthrax attacks.
But doctors, nurses and others bring new germs into rooms every time they enter, raising the question of whether sterilizing between check-ins will really lead to fewer infections.
''There's no question they can sterilize a room,'' Wellmont chief executive Dr. Richard Salluzzo says of the $180,000 machines. ''Has it prevented infection? We don't have the answer to that yet.''
He hopes to have enough data to tell by year's end.
— Nurses count surgical sponges to make sure they're all out before a patient is sewn up, but every hospital occasionally misses some. In University of Michigan operating rooms, doctors are testing sponges tagged with bar code-like radiofrequency chips. Wave a wand and a beep sounds if a sponge is still in the wound. Or, nurses can drop used sponges into a ''smart'' bucket that counts how many are missing.
''We've had a long history in medicine of this problem continuing to occur no matter what kind of very careful steps we've devised,'' says clinical affairs chief Dr. Darrell Campbell, a well-known patient safety specialist. ''We want to get to zero.''
— In U-Michigan's hospital halls, physician assistants are assigned to spy to tell if fellow workers wash hands both when entering and exiting patient rooms. Workers are better at remembering on the way in, but they don't want to carry germs back to the nurses' station or elevator buttons, either, Campbell notes. Some bugs can live on cool hospital surfaces for weeks.
There is some concern that the no-pay push could make hospitals try to hide certain errors, or just trade one problem for another. Pull a urinary catheter too soon, for example, and a fragile patient may fall going to the bathroom, says Michigan's Campbell.
''I don't know how much is really preventable,'' adds the Cleveland Clinic's Gordon. ''We want to chase zero, but we'll probably never get to zero.''
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Lauran Neergaard covers health and medical issues for The Associated Press in Washington.