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.
already for profit hospitals are limiting who they will admit....
That doesn't surprise me at all. I worked with families who had disabled children that qualified for assistance. Many could well afford private insurance and some had cancelled their employer policies because they didn't have to pay an extra premium. When Medicaid quit paying for pull-ups and went to strictly diapers...you'd have thought the world ended from all the griping and complaining.
Medicaid paid for their formula, medicines, diapers, wipes, medical equipment/physicians and specialists, plus 24 hr nursing care if they had a trach or g-tube. The taxpayers were shouldering the lion's share of responsibility and it doesn't seem kosher.
Granted, there were several families I saw who actually needed assistance, but they were the exception...not the rule.
oh so very true....I always say that our hospital spends more time trying to Look good, rather than be good...
or ...."Pres-Ganey is our god"....
oh so very true....I always say that our hospital spends more time trying to Look good, rather than be good...
or ...."Pres-Ganey is our god"....
oh so very true....I always say that our hospital spends more time trying to Look good, rather than be good...
or ...."Pres-Ganey is our god"....
oh so very true....I always say that our hospital spends more time trying to Look good, rather than be good...
or ...."Pres-Ganey is our god"....
oh so very true....I always say that our hospital spends more time trying to Look good, rather than be good...
or ...."Pres-Ganey is our god"....
Be thankful your dtr is on some type of healthcare. My unemployed son has no health care and cannot use Medicade or the “free” clinics. They say he can work and won’t accept him. He plans on going back to school, and use the university health clinic. And the only financial help he will get for school are loans. So much for the priviledged caucasian male. We are retired and I lost my job when my son lost his(same co.).
And we’ll still be dinged for “chemical restraints” as in tranquilizers, and have to sign those frequent orders for the chair alarm, the bed alarm, etc.
So it begins: the Death Panels’ opening salvo.
So...mandatory P.E. classes for old folks otherwise they aren’t covered. Just like elementary school, some things never change.
I believe the administration’s potential appointment of a Death Czar would relinquish the need for a Death Panel.
That is somewhat akin to being neither slow or fast, just halffast.
But what happens if Granny wants to go home?
If you are successful in suing a hospital for malpractice, Medicare will claim part of your judgment if you do not provide for Medicare reimbursement in the lawsuit.
Subrogation will still occur under the new policy. However, Medicare will be more active in denying payment when no lawsuit is filed for the specified medical procedures.
Well said. Sadly many traitorous republicans are even in on this Marxist line of though.
“Wonder if a preventable but “politicized disease” like AIDs will be on “the list.” “
The following will never be subject to rationing.
1, any sexually transmitted disease.
2, rectal prolapse, etc
3, abortion.
BINGO! But they won't even need to go though the formality of a waiver for "politically correct" treatments like abortion. If necessary, they will just write abortion, HIV, etc. into the thousands of pages of HHS regulations that Sebelius is so diligently writing as we speak...
So there are hospitals with the audacity to bill insurance companies for procedures performed on the wrong patient? I wonder if they try hitting up both the wrong patient’s and the right patient’s insurance companies.
I am good with that notion. You are free to smoke, drink and be a fat pig. The rest of us should not have to pay for the damage though.
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