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.
The American people should know who is on the Death Panel and be given a map of directions to their houses, pictures of their families, places of business, schools, etc. I think I’ll begin working on just that.
Texas has considered and a lot of other states will be considering dropping Medicaid. Texas did a study and found that by dropping the federal funding and requirements, they could possibly come out better by going alone with a strictly controlled state program (no abortions, no illegals, mandatory co-pays, etc.). Hopefully Texas will do it in the future.
Liberal-designed Holocaust II. Pelosi et al. want the power to decide who lives and who dies by their decree. Do you doubt that we’re all labeled in Big Bro’s database by religion, political affiliation, activism, Freeper status, and whatever else they will deem their enemies to be.
This is all more confusing than tax law.
Also, I’m starting to wonder if Karl Marx got his start selling insurance.
I love the idea of dropping it and going private. I worked Medicaid cases for the State several years ago and found the potential for fraud was enormous. Not enough oversight or control....and too many people “working the system”.
Does Medicaid/Medicare still pay for Viagra??
Oh, they’ll treat it. It’s just that YOU are going to pay for it ...through your state and local taxes ... for that hospital to stay standing.
And the “care” is going to look waaaaay different.
Hey, Cuba supposedly has the BEST care in the world, man! Now, they don’t pay their doctors anything...but heck, who cares!
I see no reason for the taxpayer to pay for that under ANY circumstances.
You take an elderly person who is confused or disoriented, put them in a bed with no side rails or a wheelchair with no lap buddy... and you're asking for disaster. If they're easily excitable, it just compounds the chances of injuries.
The reasoning? They have a "right" to fall. We live in an upside down world.
Yes, and it shouldn't pay for the births either.
Need bypass surgery for clogged arteries? It was preventable. You ate the wrong foods, therefore you are`nt covered. Hospital makes a mistake? Too bad. Not only do you have to suffer because of the mistake, you also have to pay the hospital for the mistake. Good grief. Everything is “preventable.”
My dad, by the way, when he was falling, was not confused nor disoriented. He was just very stubborn and strong-willed.
But the good news is it will pay for an inflatable suit so you won’t get hurt by a fall.
See, now you needed the suit.
“The hospital can’t refuse to treat it. They are just stuck with not getting paid.”
The day is fast approaching when hospitals WILL refuse to treat certain people, and will have armed guards at the doors to keep those people out.
I've known people who are on Medicaid and who often took a taxi to their doctor's appointment (they refused to walk three blocks to a bus stop).
Get the government the hell out of healthcare.
If the GOP was really interested in being in power and winning elections they would immediately bring out an ad high lighting this crap and pointing out that the real killers of granny are the dimwits, but since they are gutless wonders and really don't want to be the majority party in power they will let it lie.
ping
The way I read this is, Medicaid and Medicare won't pay for preventable HOSPITAL MISTAKES.
If the hospital screws up, they eat the cost.
We'll have to see how the MBA and risk management slime at hospitals change the rules to deal with this: I suspect not well for the patients. ("By consenting to treatment, indicated by my signature on this form, I give up my right to sue.")
Just like the EULA on Microsoft products.
NO cheers, unfortunately.
its no fun being a doctor out there...
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