Skip to comments.Medicaid (AND Medicare) to Quit Paying for Preventable Events ( read what they consider as such)
Posted on 06/01/2011 6:32:08 PM PDT by UniqueViews
WASHINGTON -- The Centers for Medicare and Medicaid Services (CMS) has announced that hospitals and healthcare providers will no longer be reimbursed for treating their Medicaid patients for illnesses, injuries, or readmissions that should have been prevented.
A final rule announced Wednesday enacts a portion of the Affordable Care Act (ACA) that prohibits states from making Medicaid payments to providers for conditions that are deemed "reasonably preventable."
In 2008, Medicare stopped reimbursing hospitals for treating conditions, infections, or illnesses that were acquired in the hospital, and for any readmissions associated with treating those hospital-acquired conditions.
The Medicaid list of what is preventable mirrors the Medicare list, which includes transfusing the wrong blood type; falls that result in dislocation, fractures, or head injuries; burns and electric shocks; catheter-associated urinary tract infections; surgical site infections after bariatric surgery or coronary artery bypass; and manifestations of poor glycemic control.
In addition, CMS has issued National Coverage Decisions stating that Medicare won't pay for certain so-called "never events" -- those which should never happen -- including performing the wrong procedure; performing the procedure on the wrong body part, or performing the correct procedure, but on the wrong patient.
Medicaid will also follow Medicare's lead on that issue and not pay for never events.
"These steps will encourage health professionals and hospitals to reduce preventable infections and eliminate serious medical errors," CMS Administrator Donald Berwick, MD, said in a press release. "As we reduce the frequency of these conditions, we will improve care for patients and bring down costs at the same time."
States can identify additional preventable conditions for which Medicaid payment will be denied.
The final rule is effective July 1, 2011, but gives states the option to implement between its effective date and July 1, 2012.
Since Medicare enacted its policy of not paying for preventable events, private insurers have begun to do the same.
For instance, Aetna doesn't reimburse for eight hospital-acquired infections or for three never events, according to information provided by America's Health Insurance Plans (AHIP), an industry trade group. Cigna doesn't pay for never events, reduces payments for hospital-acquired infections in certain cases, and offers payment incentives for hospitals who follow standardized protocols to improve patient safety, AHIP said.
"catheter-associated urinary tract infections; surgical site infections after bariatric surgery or coronary artery bypass; and manifestations of poor glycemic control."
Not paying for treatment of infection -- almost any infection can be claimed to be "preventable" -- , not paying for diabetes complications, if they can be blamed on "poor glycemic control" -- what is going to happen to those people -- if this isn't rationing, what is?!
They also consider preventable and won't be paying for accidents: "falls that result in dislocation, fractures, or head injuries; burns and electric shocks"
Everything is all your fault and Obamacare won't cover it. If you have an accident or acquire an illness that "THEY" consider "preventable" your medical care is not covered. And if Medicaid and Medicare won't pay for it, watch private insurance exclude those also -- for however long there is private insurance.
"Since Medicare enacted its policy of not paying for preventable events, private insurers have begun to do the same"
Instead of focusing on eliminating fraud and abuse in Medicaid and reforming Medicare, they are not paying for treatment, let them all die!
And as for things that happen in hospitals -- are all patients supposed to sue the hospital now?
Obamacare is worse than anything anyone could have imagined and this is going to get much worse.
With abortion, everything is preventable. So does that mean we will be abolishing medicare?
Well, there go the abortionists.
Just wait till the first time granny falls and breaks her hip in the hospital and they refuse to treat it because Medicare won’t pay...
You’re fat because you have poor self control and eat lots of junk food. Your heart attack and hospital stay can be directly attributed to your obesity. And since your obesity is something you refuse to control, we ain’t gonna pay for your heart attack.
No doubt that ObamaCare contributed to this.
What are the odds that if the insurer won’t pay for it, somehow it will become the financial responsibility of the patient? Oh and don’t forget that if it is related to pre-existing conditions-like you being obese or a smoker, it is YOUR FAULT and not covered either. REPEAL the entire egregious ObamaCare bill!
Pregnancy is preventable.
Pregnancy is ‘resonably preventable’. Does this mean Medicaid will no longer cover abortions?
Death Panels. Pure and Simple.
Media assists Demoncrats in saying Paul Ryan’s Budget proposal will kill Granny. Well, no, the HHS is doing it now.
Get the government the hell out of healthcare.
Oh, sweet. Under the new Medicaid rules, I would have had to pay for having my broken elbow repaired after I fell while crossing the street on an Army post. Even though the Army did an investigation and determined that I fell because it was a construction zone which I had to cross to get to the parking lot--that just confirms that the injury was preventable (they could have put the construction zone elsewhere, right?).
When you get right down to it, most conditions are preventable. Well, Obama *did* claim that Obamacare would save money.
This list is similar to existing practice with a twist. If a hospital admits neglience or neglience is demonstrated through a civil proceeding, Medicare, Medicaid, and most private insurance must be reimbursed. The legal term is subrogation. Neither government nor private insurers will initiate the proceedings. They essentially pile on the plaintiffs case, doing nothing to contribute to the case. However, they will take the plaintiffs judgment if the plaintiff does not include reimbursement.
This policy seems to be taking a more active role. Government will probably require more hospital reporting potentially increasing costs. In addition, government may decide to become the judge of these acts. Government can just refuse to pay making its own judgment. Most of the major cases are already handled through litigation and voluntary hospital settlements.
I see this policy primarily as a tool to stiff health care providers. Health care providers will in turn pass the added costs to consumers. I am not sure anyone can provide much evidence on many minor cases. Unfortunately, hospitals cannot eliminate all of these incidents. Some level of these incidents will still occur no matter the care taken.
Welcome to Obamacare! Please answer the questions from the health care police or go directly to jail.
The reps said--'No Manual, just do what you do and we'll tell you when you violate...'
I walked out and the rest of my colleagues followed.
All of these things they aren't paying for, by the way, are things happening in the hospital, not on the outside.
According to Medicare, and now Medicaid, the hospital shouldn't allow Granny to fall and break her hip. If she does, it's their fault, so they should eat the cost.
Those of us who live in the real world know that when you deal with people, things don't always go according to plan. My dad, now deceased, fell multiple times in the nursing home and the hospital. It's a wonder he never broke anything. Not a single fall was the fault of anyone but himself. He circumvented everything that was tried to keep him from falling, including incessant reminders not to get up by himself. He was determined to do it anyway. (Once he even took a nursing assistant down with him).
In an ideal world, patients would never fall, never get catheter infections, never get surgical wound infections, but we don't live in an ideal world. Sometimes the best everyone can do isn't good enough and things can happen. (I'd like to see the people who write the rules keep the diabetic's blood sugar under control when the diabetic has family members smuggling in food, or when the patient sneaks out to the vending machines in the cafeteria- or to the convenience store down the street!)
Right now this applies to hospitals. I would not be shocked to hear in the fairly near future that it applies to individual patients and providers.
Not that I agree with the policy, but they are talking about “fall that result...” that occur while you are in the hospital (and probably nursing home as well)
With the Ascended 0ne and his minions, rationing is the end game, but this rule actually makes some sense. Granny gets a hospital acquired infection but is discharged home anyway but has to be readmitted in a few days to treat the infection that the hospital was at fault for. Old system, the hospital would get two payments, one for each admission. New system the hospital no longer has incentive for a premature discharge because they will receive only one payment for the episode of care. Granny incurs no financial risk for the unnecessary second admission. Should not the hospital have some accountability for quality of care?