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Should Medicare pay for nosocomial infections?

Hospital-acquired, or nosocomial, infections are often caused by poor hospital care.  Patients arrive to the hospital and often leave with infections caused by unsanitary hospital conditions.  Should Medicare pay for these hospital-induced health care costs?

A knee jerk reaction would be to say no.  If the hospital adversely influence patient health, Medicare or other payors should not be responsible for those costs.  

However, if Medicare decided to implement a policy where they did not pay for nosocomial infections, doctors would report nearly all infections as community-acquired rather than hospital-acquired. Thus, not paying for nosocomial infections will adversely affect the reporting of these types infections.  If the infections are not reported, it will be difficult to eridicate them.

Thus, we are in a catch-22.  Paying for medical care resulting from nosocomial infections, discourages the prevention of these infections.  Not paying for medical care decreases the incentive to report an infection as nosocomial.  

Damned if you do, damned if you don’t.


  1. “if Medicare decided to implement a policy where they did not pay for nosocomial infections, doctors would report nearly all infections as community-acquired rather than hospital-acquired.”

    First off, I think we need to give physicians credit for a bit more integrity than this. Secondly, it’s not that easy to just call everything community acquired. You don’t get post-operative infection after bypass surgery from the community, for example. In other cases, it can often be demonstrated that an infection was probably hospital acquired, so I don’t think most people would be so quick to commit fraud.

    Finally, physicians revenue is not tied to whether the condition is community- or hospital-acquired. Physicians get paid separately by Medicare part B – what the hospital gets paid has no influence on the physician. The hospital can encourage the physician to properly document that something was community acquired when it is, but the MD is not compelled to do anything unethical.

    As a side note, by and large the nosocomial infections that Medicare has targeted are not reportable infectious diseases (like Tuberculosis, Syphilis, Measles, etc). Public health officials are not depending on proper documentation to “eradicate” them.

    Nevertheless, this is indeed a controversial topic. The most cogent argument is the lack of 100% effectiveness of preventive strategies, i.e. you can do everything right and the patient still gets an infection (and the hospital doesn’t get paid for it’s trouble). This is even more true for some of the other hospital acquired conditions like DVT following certain orthopedic procedures.

    Despite the fact that it’s an imperfect solution for a huge problem, it’s a good first step, and it has opened up the dialogue to lead to more refined interventions down the line.

  2. As a correction to my previous statement about reporting, the US Government Accountability Office (GAO) just recently released a report to the House completed in September summarizing states’ initiatives/requirements for reporting of hospital acquired infections. There are in fact 23 states with a variety of mandated conditions to report. Most of these use the CDC’s National Healthcare Safety Network to accomplish this, and most have just started collecting data in the last 18 months. My apologies. You can find more information here:

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