Medicare and Bedsores

As of October 1, 2008, Medicare no longer pays for bedsores that develop during the course of a hospital stay. Some private insurers may be following suit as well, which could mean a significant financial impact on both the health industry and the patients who rely on it. Bedsores, along with other preventable conditions, lead to longer recovery times, and a slew of complications including infections which can cause patient death in severe cases. Because of the expensive treatments that bedsores require, and because of the fact that bedsores are largely preventable with proper measures in place, Medicare believes that it is not prudent to pay for bedsore treatment, as it amounts to rewarding hospitals for poor performance in terms of patient care.

However, Medicare does pay for the prevention measures necessary in order to reduce the chances that a patient will develop bedsores during his or her hospital stay. This means that the specialized bedding and equipment, nutritional measures, and other prevention options may be covered depending upon your particular situation. When in doubt, your best course of action is to inquire about your coverage directly, in order to avoid potential confusion and increased financial charges.

Medicare’s zero-tolerance stance on bedsores is encouraging hospitals throughout the country to improve their prevention methods – some hospitals regularly page nurses in order to remind them to turn their patients. Others have a hospital-wide alert, either in the form of music or chimes that helps nurses to remember this essential duty.

If you or your loved one developed a bedsore while hospitalized before October 1, 2008, treatment options may still be covered for you. Talk to your Medicare representative in order to find out whether or not your treatment will still be covered. Regardless as to whether or not your treatment is covered under Medicare, the hospital is obligated by law to provide you with adequate care for all of your conditions, including bedsores.