CMS:
Medicaid will not pay hospitals for preventable conditions
Topics: Medicaid, Reimbursement, Finance, Never Event, Medical Errors, Quality, Performance Improvement, Safety
June 02, 2011
CMS on Wednesday announced that Medicaid will no longer reimburse hospitals and health care providers for treating certain preventable conditions.
The final rule enacts a provision of the federal health reform law that bars states from paying providers for conditions deemed "reasonably preventable," MedPage Today reports. Although the final rule takes effect on July 1, 2011, states have until July 1, 2012, to implement the program under the overhaul. Twenty-one states already have instituted nonpayment policies for preventable conditions.
Medicaid's list of preventable conditions closely mirrors the list used for Medicare, which stopped reimbursing hospitals for such conditions in 2008. The final rule requires states at minimum to adopt the Medicare list, but it also allows them to implement "more stringent laws or regulations" if approved by CMS. Conditions on the list include:
Air embolism;
Blood incompatibility;
Catheter-related infections;
Falls that result in injury;
Foreign object retained after surgery;
Severe bedsores; and
Surgical site infections.
According to MedPage Today, CMS also has issued National Coverage Decisions, which state that Medicare will not pay for certain "never events," such as performing the wrong procedure, performing a procedure on the wrong body part, and performing a procedure on the wrong patient. Medicaid also is expected to cease payment for never events.
"These steps will encourage health professionals and hospitals to reduce preventable infections, and eliminate serious medical errors," CMS Administrator Donald Berwick said. He added, "As we reduce the frequency of these conditions, we will improve care for patients and bring down costs at the same time" (Walker, MedPage Today, 6/1; McKinney, Modern Healthcare, 6/1 [subscription required]; Fox, National Journal, 6/1 [subscription required]).
