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NY Medicaid to deny payment for hospital errors

By Valerie Bauman
The Associated Press
Copyright 2008 The Associated Press

ALBANY, N.Y. — When patients walk into a hospital they generally expect to walk out healthier — and some things are just never supposed to happen. Soon, New York hospitals won’t be able to bill Medicaid for mistakes during surgery, medication errors and other deadly complications caused by preventable hospital blunders.

The state Department of Health tracks these “never events,” or mistakes that should never happen. In October, Medicaid will stop paying for things like wrong-site surgery, wrong patient procedures, disability associated with treatment, medication errors and other problems.

The idea is to shift the burden to hospitals, practices and doctors if they make a dangerous mistake.

Last year, New York had 20 medical cases where a procedure was performed on the wrong patient or the wrong body part.

In another 106 cases, officials found incorrect procedures or treatments, or wrong patient invasive procedures — more than the 95 reported in 2006. In 2007, New York hospitals also had 26 cases where a medication error occurred, six resulting in permanent patient harm, 11 nearly killing the patient, and nine cases where the patient died, according to the health department.

In 122 cases in 2007, medical professionals left foreign objects inside a patient’s body cavity after surgery. That’s slightly down from 129 in 2006.

The state health department expects to save $6 million from the change. New York’s Medicaid program is among the most expensive in the nation, costing taxpayers $47 billion a year.

Health officials say New York is following the lead of the federal Centers for Medicare and Medicaid, but patients won’t get stuck with the tab.

“We will not allow a patient to be billed as a result of complications caused by the hospital for which Medicaid has denied payment,” agency spokeswoman Claudia Hutton said in an e-mail. “Medically necessary care, including care required as a result of an error or hospital-induced complication, is covered by Medicaid. If a patient seeks treatment at another hospital to remove a foreign object, Medicaid will cover the cost of the procedure since the patient presented at admission with the foreign object.”

William Van Slyke is a spokesman for the Healthcare Association of New York State, which represents hospitals. Van Slyke said the association had previously adopted its own policies for never events, but questioned portions of the new plan.

He said what the health department considers preventable in all cases “may not always be preventable by a hospital.”

Since 1985 New York has required hospitals to report adverse events — anything with a poor outcome, but not necessarily because of an error by the medical staff.

“We’re interested in improving health care and making it as safe as we can,” said Dr. John Morley, medical director of the Office of Health Systems Management.

The Medical Society of the State of New York, which represents doctors, did not return calls for comment.