In one of the darker ironies in American health care, hospitals are often paid extra to treat the problems that arise
when they make mistakes. Starting late next year, Medicare won’t pay for treatment for some conditions associated
with screw-ups.

Under a little-noticed new rulebook that came down last week, Medicare will return the bill unpaid for care to
solve these problems:

• Bed-sores
• Two kinds of catheter-associated infections
• Air embolism, or bubbles of air or gas entering the bloodstream during medical procedures
• Mediastinitis (infection of the area between the lungs) after coronary bypass surgery
• Giving patients the wrong blood type
• Leaving objects inside surgery patients
• In-hospital falls

The government estimates its direct savings at about $20 million a year, and Medicare has said hospitals can’t turn
around and stick patients with the tab. Other insurers are likely to follow suit, and hospitals may well do a better job
for all patients, not just those on Medicare, say some advocates of the new rules.

The American Hospital Association had proposed a narrower list, saying some bedsores and hospital-acquired
infections occur even with top-notch care. The trade group wanted only “never events” — such as air embolism,
blood incompatibility and leaving objects inside patients — unreimbursed.

Consumers Union, which has been campaigning for better control of hospital infections, generally applauded the
new rules. “We think it’s going to be a very powerful incentive for hospitals to improve care, and also a way to
contain costs,” spokesman Michael McCauley told the Health Blog.