New Medicare payment guidelines could reduce medical errors

On behalf of John Gismondi

Medicare payments focusing more on quality rather than quantity of care

Recent federal legislation has brought big changes to the health care industry, but a significant change that tends to get overlooked by many media outlets is Medicare reform. According to, Medicare has been changing the way it reimburses hospitals in recent years by moving away from a health care model based on quantity of care and towards one focused on quality. Experts hope that the changes will result in a reduction in hospital errors, such as high infection rates and patient injuries.

Medicare changes

In the past, hospitals were reimbursed by Medicare on a fee-for-service basis. That system meant that so long as hospitals performed a legitimate medical procedure then those hospitals would be reimbursed by the federal government. The system gave hospitals an economic incentive to perform more medical procedures since they would receive more funding based on the quantity of procedures performed.

The problem with that system is that it placed little emphasis on the quality of care patients received. So long as a procedure was legitimate, its quality or effectiveness had little impact on a hospital’s Medicare funding. That situation is changing, however, with Medicare increasingly basing its reimbursement scheme on value-based purchasing. Medicare is aiming to have 90 percent of its payments linked to quality, rather than quantity, of care received by 2018.

Hospital errors

In recent months, for example, Medicare has taken an especially strong focus on reducing hospital errors, particularly high infection rates. According to NBC News Philadelphia, in December Medicare announced that over 700 hospitals would see their Medicare funding cut because of high rates of infections and patient injuries. The fines hit many of the nation’s most recognized health care facilities, including Philadelphia’s Hospital of the University of Pennsylvania and Danville’s Geisinger Medical Center.

Late last year, Medicare also fined hospitals that suffered from high readmission rates, which occur when a patient has to return to a hospital within 30 days of being discharged. A high readmission rate is often an indication that patients failed to receive quality care during their first hospital visit. The fines levied by Medicare over readmission rates affected the majority of hospitals in Pennsylvania.

Medical malpractice

These recent changes will hopefully bring about better care for patients in hospitals both in Pennsylvania and throughout the country. Yet, as these recent fines show, at the current time receiving quality care is far from guaranteed when patients enter a hospital.

Errors made by hospitals can have a devastating impact on patients and their families, including injuries and even death. Anybody who has been affected by a hospital’s possible negligence should contact a medical malpractice attorney today. An experienced attorney can help injured patients understand what the implications of a potential medical error are and what options may be available to them.