Patients falling down in hospitals is a dangerous and costly problem. About one in five patients will be injured in a fall, raising their bill by about $4,000 on average. Medicare refuses to pay for care stemming from what it considers preventable falls. But falls in general aren’t as preventable as one might think. Patients are sometimes disoriented or impaired to begin with, which is then compounded by medications given to them during their hospitalization.
An opinion piece in the New England Journal of Medicine argues that Medicare’s reluctance to pay for fall-related care will encourage hospitals to restrain more patients, which can have adverse outcomes. With hospitals on the hook for any fall-related care, they may use restraints as a preventable measure, but doing so is not in the best interest of the patients. They point to research showing that restraints can cause bed sores, breathing trouble, and cause general discomfort as reasons why hospitals should use them judiciously. Monitoring or other means would be preferable to restraints, but Medicare has not provided guidelines on preventing falls, so the concern is that hospitals may opt for restraints as an easy solution. Until guidelines are provided by Medicare for avoiding preventable falls, their insistence that falls be classified as no-pay events may only harm patients in the long run.
See the piece in NEJM and a news story about the issue.
