Do hospitals still get reimbursed when they make errors?
Such reimbursements send the wrong message and implicitly try to excuse medical practice. So in an effort to trim health care costs and improve healthcare quality, the Centers for Medicare and Medicaid Services (CMS) announced its decision to deny Medicaid reimbursement to healthcare providers treating patients for preventable illnesses, injuries and readmissions. The new rule - enacted July 1 - gives states a full year to implement the changes. During that time, states may identify additional preventable conditions that will be denied reimbursement.
The decision simply extends the terms outlined in the Affordable Care Act (ACT) of 2008 to Medicaid reimbursement. Until now, ACT provisions applied only to Medicare, effectively denying reimbursement to providers failing to rein in "reasonably preventable" conditions.
Like Medicare, Medicaid's new list of preventable conditions includes:
•· Giving patients the wrong type of blood during transfusions
•· Patient falls that cause dislocations, fractures or head injuries
•· Patient burns and electric shocks
•· Catheter-linked urinary tract infections
•· Surgical site infections following bariatric or coronary artery bypass surgery
•· Complications related to poor blood sugar control
CMS Now Refuses to Pay for "Never Events"
"Never events" - events that should never happen - have also been added to CMS's list of non-reimbursable situations. These include performing the wrong procedure, doing the procedure on the wrong body part or doing the correct procedure on the wrong patient. Both Medicare and Medicaid will deny "never event" reimbursement.
Since Medicare began refusing payment for preventable conditions, private insurers have joined in, either by denying reimbursement, reducing reimbursement or providing incentives to hospitals that follow standardized patient safety protocols, according to America's Health Insurance Plans (AHIP). The move is inducing hospitals to closely examine routine practices and find ways to improve.
