Medicare’s No-Pay Rule Is Small Potatoes for Hospitals’ Bottom Line

Posted by Jacob Goldstein in the Wall Street Journal Health blog Starting tomorrow, Medicare won’t pay hospitals for costs associated with a handful of complications the feds say are preventable. Some of the complications — such as bedsores, patient falls and blood clots in the veins after certain surgeries — are fairly common. But as it turns out, the program’s effect on the bottom line looks to be minimal. Medicare estimates the no-pay rules will cut off about $21 million in payments during the fiscal year that starts Oct. 1. That’s a vanishingly small sum when you consider that Medicare’s total payments to hospitals for the year will be more than $100 billion. Why so small? Under the current system, payments for the conditions on the list only come into play for plain-vanilla patients whose care becomes more complicated as a result of the complications. But many Medicare patients are not plain vanilla.