As part of its continued effort to improve patient safety and contain health care expenditures, in August 2007 the Centers for Medicare & Medicaid Services (CMS) announced it would no longer reimburse providers for “conditions that could reasonably have been prevented.” In shifting this burden to hospitals and physicians, CMS focused on a list of specific complications called “never events,” meaning they should never occur in the hospital.
Since then, CMS’s program has been adopted by private insurance companies as well, hoping to save money inside the Federal Government’s shadow. This week, CMS announced that the same rules would apply for Medicaid patients, and that hospitals and other health care providers will no longer be reimbursed for illnesses, injuries, or readmissions that should have been prevented, or in this particular instance under the Patient Protection and Affordable Care Act (PPACA), are ”reasonably preventable.”
The Medicaid list is similar to that of Medicare, including:
- transfusing the wrong blood type
- certain falls that result in injury
- fractures, or head injuries
- burns and electric shocks
- catheter-associated urinary tract infections
- surgical site infections after certain procedures, such as bariatric surgery or coronary artery bypass
Medicaid will also follow Medicare’s lead not pay for “never events,” such as performing the wrong procedure, conducting surgery on the wrong part of the patient, or even conducting the correct procedure, but on the wrong patient. CMS Administrator Donald Berwick, MD, stated in a press release. ”These steps will encourage health professionals and hospitals to reduce preventable infections and eliminate serious medical errors. As we reduce the frequency of these conditions, we will improve care for patients and bring down costs at the same time.”
The final rule is effective July 1, 2011, but CMS will permit states the option to implement between July 1, 2011 and July 1, 2012.
To see the regulations, click HERE.