{"id":850,"date":"2022-05-24T20:26:17","date_gmt":"2022-05-24T20:26:17","guid":{"rendered":"https:\/\/www.janiceklaw.com\/?p=850"},"modified":"2025-08-08T15:43:14","modified_gmt":"2025-08-08T15:43:14","slug":"seguro-medico-del-estado","status":"publish","type":"post","link":"https:\/\/www.janiceklaw.com\/es\/blog\/medicare\/","title":{"rendered":"Medicaid and Medicare Health Outcomes Survey"},"content":{"rendered":"<p>De acuerdo a un <a href=\"https:\/\/oig.hhs.gov\/oei\/reports\/OEI-06-18-00400.asp\" target=\"_blank\" rel=\"noreferrer noopener\">informe mayo 2022<\/a> publicado por la Oficina del Inspector General (OIG) del Departamento de Salud y Servicios Humanos de EE. UU., aproximadamente 1 de cada 4 estadounidenses (25%) sufri\u00f3 da\u00f1os temporales o permanentes durante las estad\u00edas en el hospital en octubre de 2018. Estos eventos adversos para la salud ocurrieron bajo la cobertura de Medicare, que es uno de los mayores proveedores de cobertura de salud en Estados Unidos. De hecho, <a href=\"https:\/\/www.medicaid.gov\/medicaid\/program-information\/medicaid-and-chip-enrollment-data\/report-highlights\/index.html\" target=\"_blank\" rel=\"noreferrer noopener\">casi 80 millones de estadounidenses<\/a> recibir cobertura de Medicare.<\/p>\n\n\n\n<p>Si bien esta estad\u00edstica reci\u00e9n publicada es alarmante, muestra una ligera disminuci\u00f3n en el da\u00f1o al paciente durante la \u00faltima d\u00e9cada. Seg\u00fan un estudio de la OIG publicado en 2010, aproximadamente el 27% de los pacientes de Medicare sufrieron da\u00f1os durante su estad\u00eda en el hospital en octubre de 2008. Este estudio original estima que alrededor del 50% de estos eventos adversos en hospitales comunitarios se pudieron prevenir. Estos eventos da\u00f1inos tambi\u00e9n fueron muy costosos y le costaron al seguro de salud de Medicare alrededor de $324 millones en reembolsos y deducibles.&nbsp;<\/p>\n\n\n\n<p>El objetivo de estudios del gobierno federal como estos es mejorar la atenci\u00f3n m\u00e9dica y la seguridad del paciente en los Estados Unidos. Esto se debe a la alarmante cantidad de muertes anuales causadas por <a href=\"https:\/\/www.janiceklaw.com\/es\/abogados-de-negligencia-medica-en-san-antonio\/\">negligencia m\u00e9dica.<\/a> De hecho, <a href=\"https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK2673\/\" target=\"_blank\" rel=\"noreferrer noopener\">un informe de 1999<\/a> publicado por el Instituto de Medicina (IOM) afirma que los errores m\u00e9dicos en los hospitales causan hasta 100,000 muertes en los estadounidenses cada a\u00f1o. Desde que el IOM public\u00f3 este informe, el gobierno de los Estados Unidos, los proveedores de atenci\u00f3n m\u00e9dica y las compa\u00f1\u00edas de seguros m\u00e9dicos han estado trabajando juntos para generar menos errores m\u00e9dicos. Por ejemplo, uno de los errores m\u00e9dicos m\u00e1s comunes y peligrosos en los EE. UU. involucra medicamentos recetados. <a href=\"https:\/\/www.amcp.org\/about\/managed-care-pharmacy-101\/concepts-managed-care-pharmacy\/medication-errors\" target=\"_blank\" rel=\"noreferrer noopener\">Un informe de 2019<\/a> de la Academy of Managed Care Pharmacy (AMCP) estima que <a href=\"https:\/\/www.janiceklaw.com\/es\/abogados-de-negligencia-medica-en-san-antonio\/error-de-medicacion\/\">errores de medicaci\u00f3n<\/a> y las lesiones por drogas en los hospitales acumulan aproximadamente $3.5 mil millones cada a\u00f1o.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">Tipos de da\u00f1os que experimentaron los pacientes de Medicare<\/h2>\n\n\n\n<p>El estudio de la OIG incluy\u00f3 a 770 pacientes cubiertos por el seguro de salud de Medicare. Estos pacientes sufrieron dos tipos principales de da\u00f1os en octubre de 2018. 12% sufri\u00f3 eventos adversos que resultaron en lesiones permanentes, estad\u00edas hospitalarias m\u00e1s prolongadas, intervenciones para salvar vidas e incluso la muerte. Mientras tanto, 13% experiment\u00f3 eventos de salud que solo causaron da\u00f1os temporales. El da\u00f1o temporal puede haber requerido alg\u00fan tipo de intervenci\u00f3n m\u00e9dica, pero a diferencia de los pacientes que sufrieron eventos adversos, estos pacientes no necesitaron hospitalizaciones m\u00e1s prolongadas ni intervenciones para salvarles la vida.&nbsp;<\/p>\n\n\n\n<p>El estudio desglosa a\u00fan m\u00e1s los eventos de da\u00f1o espec\u00edficos. Afirma que 43% de los pacientes del hospital involucrados en este estudio se vieron perjudicados por errores de medicaci\u00f3n. La cobertura de medicamentos recetados de Medicare ten\u00eda que cubrir los costos de todas las estad\u00edas prolongadas en el hospital y las intervenciones para salvar vidas. Mientras tanto, 23% de los eventos de da\u00f1o fueron causados por la falta de atenci\u00f3n adecuada al paciente, 22% fueron causados por procedimientos y cirug\u00edas, y 11% fueron causados por infecciones adquiridas en el hospital.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">Prevenibilidad de estos eventos de da\u00f1o<\/h2>\n\n\n\n<p>Para hacer que estas estad\u00edsticas sean m\u00e1s aterradoras, el estudio de la OIG tambi\u00e9n afirma que 43% de estos eventos da\u00f1inos fueron completamente prevenibles. Esto significa que los estadounidenses est\u00e1n sufriendo m\u00e1s traumas m\u00e9dicos de los necesarios porque los m\u00e9dicos no est\u00e1n atendiendo adecuadamente a sus pacientes. Este estudio tambi\u00e9n concluye que alrededor del 56% de eventos da\u00f1inos no se pudieron prevenir a pesar de que los profesionales m\u00e9dicos siguieron los protocolos adecuados.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">Costos de eventos de da\u00f1o para los Centros de Servicios de Medicare\/Medicaid (CMS)<\/h2>\n\n\n\n<p>23% de los 770 pacientes que sufrieron eventos da\u00f1inos prevenibles o no prevenibles necesitaron m\u00e1s tratamiento m\u00e9dico. Naturalmente, este tratamiento m\u00e9dico result\u00f3 en m\u00e1s costos cubiertos por los beneficios de Medicare. Si bien la OIG no proporcion\u00f3 una etiqueta de precio espec\u00edfica, estiman que estos eventos da\u00f1inos costaron cientos de millones de d\u00f3lares solo en octubre de 2018.<\/p>\n\n\n\n<figure class=\"wp-block-gallery has-nested-images columns-default is-cropped wp-block-gallery-1 is-layout-flex wp-block-gallery-is-layout-flex\">\n<figure class=\"wp-block-image size-large\"><img fetchpriority=\"high\" decoding=\"async\" width=\"1200\" height=\"648\" data-id=\"853\" src=\"https:\/\/www.janiceklaw.com\/wp-content\/uploads\/2022\/05\/1-in-4-Elderly-Americans-on-Medicare-Harmed-in-Hospitals-1-1200x648.jpg\" alt=\"seguro m\u00e9dico del estado\" class=\"wp-image-853\" srcset=\"https:\/\/www.janiceklaw.com\/wp-content\/uploads\/2022\/05\/1-in-4-Elderly-Americans-on-Medicare-Harmed-in-Hospitals-1-1200x648.jpg 1200w, https:\/\/www.janiceklaw.com\/wp-content\/uploads\/2022\/05\/1-in-4-Elderly-Americans-on-Medicare-Harmed-in-Hospitals-1-800x432.jpg 800w, https:\/\/www.janiceklaw.com\/wp-content\/uploads\/2022\/05\/1-in-4-Elderly-Americans-on-Medicare-Harmed-in-Hospitals-1-768x415.jpg 768w, https:\/\/www.janiceklaw.com\/wp-content\/uploads\/2022\/05\/1-in-4-Elderly-Americans-on-Medicare-Harmed-in-Hospitals-1-1536x829.jpg 1536w, https:\/\/www.janiceklaw.com\/wp-content\/uploads\/2022\/05\/1-in-4-Elderly-Americans-on-Medicare-Harmed-in-Hospitals-1.jpg 2000w\" sizes=\"(max-width: 1200px) 100vw, 1200px\" \/><\/figure>\n<\/figure>\n\n\n\n<h2 class=\"wp-block-heading\">Recomendaciones para los Centros de Servicios de Medicare y Medicaid (CMS) y la Agencia para la Calidad de la Investigaci\u00f3n de Atenci\u00f3n M\u00e9dica (AHRQ)<\/h2>\n\n\n\n<p>Aunque EE. UU. tiene algunos de los mejores servicios de atenci\u00f3n m\u00e9dica del mundo, todav\u00eda tiene muchos defectos. Y con lo que paga el estadounidense promedio por su plan de salud, es fundamental que los hospitales y los profesionales m\u00e9dicos de todo el mundo prioricen la seguridad del paciente. Una disminuci\u00f3n gradual de los eventos nocivos no solo salvar\u00e1 vidas, sino que tambi\u00e9n ahorrar\u00e1 dinero.&nbsp;<\/p>\n\n\n\n<p>Es por eso que la OIG concluy\u00f3 su estudio con recomendaciones tanto para los Centros de Servicios de Medicare\/Medicaid (CMS) como para la Agencia para la Investigaci\u00f3n y la Calidad de la Atenci\u00f3n M\u00e9dica (AHRQ).&nbsp;<\/p>\n\n\n\n<p>En primer lugar, la OIG recomienda que el CMS ampl\u00ede su lista de condiciones adquiridas en el hospital. De esa manera, la lista incluir\u00e1 m\u00e1s condiciones que son comunes, prevenibles y costosas. El estudio tambi\u00e9n sugiri\u00f3 que el CMS ampl\u00ede las m\u00e9tricas de seguridad del paciente en las demostraciones y desarrolle una gu\u00eda para los encuestadores que eval\u00faan el cumplimiento del hospital y realizan un seguimiento de la atenci\u00f3n al paciente.<\/p>\n\n\n\n<p>En cuanto a las recomendaciones creadas para la AHRQ, la OIG sugiere que la agencia del gobierno federal use de manera efectiva el Sistema de revisi\u00f3n de calidad y seguridad, cree un modelo efectivo que difunda informaci\u00f3n sobre c\u00f3mo mejorar la seguridad del paciente y cree nuevas estrategias para evitar que los pacientes sufran de condiciones comunes adquiridas en el hospital.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">Are Medicare Patients At a Higher Risk of Malpractice?<\/h2>\n\n\n\n<p>Yes, Medicare patients are at a higher risk of medical malpractice. This is largely due to the following:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Medicare generally covers individuals 65 and older.<\/li>\n\n\n\n<li>Older Medicare patients are more likely to undergo procedures, surgeries, or inpatient stays. These all increase exposure to negligent care.<\/li>\n\n\n\n<li>Hospitals with high numbers of Medicare patients may face staffing shortages, rushed medical care, or diagnostic delays. All of these increase malpractice risks. <\/li>\n\n\n\n<li>Medicare patients are frequently transferred between primary doctors, specialists, hospitals, and rehabilitation centers. This can lead to miscommunication, medication errors, misdiagnosis, and missed diagnosis. <\/li>\n<\/ul>\n\n\n\n<p>While Medicare coverage itself doesn\u2019t cause medical malpractice, the patient population that Medicare serves is more vulnerable to medical errors.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">Are Medicaid Patients At a Higher Risk of Malpractice?<\/h2>\n\n\n\n<p>Yes, Medicaid patients are at a higher risk of malpractice for several reasons that are mostly systemic and socioeconomic:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Many top specialists and hospitals limit or refuse Medicaid patients. They do so because of lower reimbursement rates. This results in Medicaid patients receiving medical care from less experienced providers and overburdened facilities.<\/li>\n\n\n\n<li>Medicaid patients are often forced to wait longer and have access to fewer preventive medical services. This increases the risk of late or missed diagnosis. <\/li>\n\n\n\n<li>Because of lower reimbursement rates, Medicaid patients are more likely to receive medical treatment at facilities with fewer resources, outdated medical equipment, and fewer staff.<\/li>\n\n\n\n<li>Medicaid serves those with lower incomes. According to the <a href=\"https:\/\/www.kff.org\/medicaid\/issue-brief\/5-key-facts-about-medicaid-coverage-for-adults-with-chronic-conditions\/\">Kaiser Family Foundation<\/a>, three\u2011quarters of non\u2011elderly patients enrolled in Medicaid report having at least one chronic condition. Additionally, nearly one\u2011third have three or more chronic conditions. These stats are significantly higher compared to patients with private insurance. <\/li>\n<\/ul>\n\n\n\n<h2 class=\"wp-block-heading\">Is Medicaid Worse Than Private Insurance?<\/h2>\n\n\n\n<p>Research shows that Medicaid patients who are undergoing surgery generally are sicker beforehand, have longer hospitalizations, higher readmissions, and worse postoperative outcomes when compared to patients with private insurance. This is noted in a <a href=\"https:\/\/record.umich.edu\/articles\/study-shows-worse-health-higher-costs-medicaid-patients\/\">University of Michigan study<\/a>. Additionally, the <a href=\"https:\/\/www.heritage.org\/health-care-reform\/report\/medicaid-provides-poor-quality-care-what-the-research-shows\/\">Heritage Foundation<\/a> also found that Medicaid patients often experience delayed diagnoses, medical care from less skilled physicians or surgeons, and have higher mortality rates.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">Is Medicaid Worse Than No Insurance?<\/h2>\n\n\n\n<p>El <a href=\"https:\/\/en.wikipedia.org\/wiki\/Oregon_Medicaid_health_experiment.\">Oregon Health Insurance Experiment<\/a> showed that Medicaid patients had more preventive visits, better monitoring for chronic conditions, and improved mental health outcomes as opposed to patients who didn&#8217;t have insurance.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">Why Do Doctors Refuse Medicaid Patients?<\/h2>\n\n\n\n<p>Doctors refuse Medicaid patients for a combination of reasons. The most significant reasons doctors refuse Medicaid patients include:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Medicaid pays doctors significantly less than private insurance or Medicare. Sometimes, the Medicaid reimbursement doesn&#8217;t even cover the cost of the medical care provided. <\/li>\n\n\n\n<li>Medicaid billing involves much more paperwork. This billing comes with complex rules. Additionally, Medicaid reimbursements are much slower than private insurance payments. These factors make it more difficult for providers to manage billing efficiently. Furthermore, because Medicaid is state-run, reimbursement rates and rules differ, and in some states, participation is less practical for providers.<\/li>\n\n\n\n<li>Medicaid patients are statistically more likely to miss appointments. Privately insured patients have insurance taken out of their paychecks and may face a higher sense of duty to show up for scheduled visits. <\/li>\n\n\n\n<li>According to the study referenced above, Medicaid patients are more prone to having multiple chronic conditions. This requires more time from physicians without a higher payment, resulting in financial losses for the practice. <\/li>\n<\/ul>\n\n\n\n<p>Many doctors who limit or refuse Medicaid patients are not doing so out of disregard for those patients. Many physicians are trying to navigate a healthcare system that has serious financial and administrative constraints. Medicaid does play a crucial role in helping millions of Texans get access to healthcare. However, the structure of the Medicaid program often puts excessive pressure on smaller medical practices and specialists who already have limited resources.<\/p>\n\n\n\n<p>In practice, this makes it harder for Medicaid patients to find quality medical care, especially in rural areas or locations that are underserved. This is not because providers don&#8217;t want to help, but because the Medicaid system doesn&#8217;t make it sustainable for them to consistently treat Medicaid patients and keep their practice open.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">Via What Entry Are Medicare and Medicaid Sanctions and Malpractice History Checked?<\/h2>\n\n\n\n<p>Medicare and Medicaid sanctions and malpractice history are checked through the <a href=\"https:\/\/www.npdb.hrsa.gov\/\">Banco Nacional de Datos de Profesionales (NPDB)<\/a>.<\/p>\n\n\n\n<p>So, if a patient wants to check whether a doctor or healthcare provider has a history of Medicare or Medicaid sanctions or malpractice problems, most of that information is stored in the link above.<\/p>\n\n\n\n<p>Hospitals, insurers, and government agencies use this to look up any serious issues related to medical malpractice claims or sanctions. They do this by submitting a <a href=\"https:\/\/www.npdb.hrsa.gov\/hcorg\/aboutReports.jsp\">Query<\/a> using the provider\u2019s name or their <a href=\"https:\/\/nppes.cms.hhs.gov\/\">National Provider Identifier (NPI)<\/a>. The NPI is essentially an ID number for doctors.<\/p>\n\n\n\n<p>The NPDB can show the following:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Past malpractice payouts<\/li>\n\n\n\n<li>Medicare or Medicaid exclusions<\/li>\n\n\n\n<li>License suspensions<\/li>\n\n\n\n<li>Hospital discipline or privilege restrictions<\/li>\n<\/ul>\n\n\n\n<p>For Medicare-related violations, agencies can also search the <a href=\"https:\/\/exclusions.oig.hhs.gov\/\">Office of Inspector General (OIG) Exclusions List<\/a> to determine if someone is banned from billing federal health programs.<\/p>\n\n\n\n<p>However, these searches aren&#8217;t available to the public with names attached. Many researchers and journalists look at the trends using the <a href=\"https:\/\/www.npdb.hrsa.gov\/resources\/publicData.jsp\">NPDB Public Use File<\/a>. This shows the data without naming any providers.<\/p>","protected":false},"excerpt":{"rendered":"<p>According to a May 2022 report released by the U.S. Department of Health and Human Services Office of Inspector General (OIG), approximately 1 in 4 Americans (25%) suffered either temporary or permanent harm during hospital stays in October 2018. These adverse health events occurred under Medicare coverage, which is one of the largest health coverage [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":854,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[39],"tags":[],"class_list":["post-850","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-medical-malpractice"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.2 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Medicaid and Medicare Health Outcomes Survey | Janicek Law<\/title>\n<meta name=\"description\" content=\"Medicaid and Medicare Health Outcomes Survey shows how patients rate their care, health status, and chronic condition management outcomes.\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" 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