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.
Agreed...the candidate who does will win. Period.
I think they mean “actionable mistakes by the hospital”
Ummm, no. These are all things that are the hospitals fault. What Medicare is saying is that if the hospital causes something bad to happen to you while you are under their care, they have to fix it for free, and not on the taxpayers dime. And I'd say it's about time.
No it won’t pay for births.
With "Abby Normal's" brain in it.
trial lawyers must have wanted this so now medicare can’t seek an offset from law suit proceeds.
Or pregnancy, labor, and delivery?
I think this thread is another example of people just showing their anger towards the government instead of just using common sense. Another way of interrperting part of this rule is that tax dollars will no longer go to a hospital that performs the right operation on the wrong patient. How is that not common sense and why the heck has it taken so long for us not to reinburse hospitals for being a bunch of idiots?
Now we just need the other commonsense piece to take place. Stop forcing hospitals to take patients that can’t afford healthcare at all, ie the emergency room.
This is in regard to the MRSA infections. The hospitals will now have to eat the costs associated with them.
My dad had a brutal one after heart surgery at Yale New Haven Hospital. They are lucky they didn’t face a lawsuit over it. I personally witnessed very careless handling of supposedly sterile equipment like IV needles, bags and such and I told them so. This after the infection was already being treated.
Hospitals simply have to start taking greater care with these things.
Once the government becomes involved, complications of all kinds arise. When the government stopped paying for infections that could have been prevented, then the infection rate went down. Why? Because there was no incentive previously for scrupulous attention to infection control since Uncle Sugar Daddy was footing the bill. So, government causes a problem and then creates more problems when it attempts to solve the problem it caused.
Government health care leads to overuse, rationing, higher prices, and worse care. It is the worst of all possible worlds.
Most MRSA infections are community aquired.
The hospital that I work in tests patients coming in for surgery for MRSA prior to the procedure.
If they get a MRSA infection postop ( and tested positive for MRSA preop)- it is not the hospitals fault.
What I see happening is that doctors and hospitals will refuse to treat high risk patients- especially obese patients, MRSA positive patients, AIDs patients,etc. who have a higher risk of infection due to their obesity or immunocompromised status.
So accident no longer means accident? But instead, accidents are preventable events and therefore not accidents?
Take driving your car as an example. It’s true that you had an accident, but that was really preventable because you had a steering wheel to miss the accident, brakes to stop before an accident became an accident, and a cell phone for telling the knotheads to get out of the way so the accident that was pending could never become an accident because it was by manner of reasonable forewarning a preventable event.
So, we should be more clairvoyant... or what?
Guess that’s why illegal aliens continue to get free health care: they’re here illegally and apparently from their proliferation non-preventable.
OK, everyone, where do you draw the line? Stand up and join forces with the rest of us and declare war on the leftists in Washington and nationwide NOW.
Organize with like minded people and fight this damn war at the ballot box with everything you’ve got. Go door to door, organization to organization, and gather support and boots on the ground to man/woman the push for the conservative vote in 2012. THIS IS OUR PEARL HARBOR...THIS IS OUR WORLD WAR II. We lose this vote in 2012, and WE LOSE OUR CONSTITUTION, OUR FREEDOM AND LIBERTY, OUR UNITED STATES OF AMERICA, OUR WAY OF LIVING, CAPITALISM. Let not the sacrifices of our fighting men and women be for naught. We are Americans, and we are victorious fighters for what is right, for our country. It’s time to put up or shut up.
Let’s get off our rear ends and start talking to people...attend any group gathering of any social kind and and let your knowledge be known about what is happenning and what will happen to this country if we do not win the vote in 2012. Join Tea Party groups, Americans for Prosperity, Freedom Works, any of the Glenn Beck’s 912 groups (check his web site out for a listing of them all.) You can add names of other groups to this list..we need to pass this info on.
Organize and fight....this is war. We The People will not be slaves to the likes of obama, soros, socialists/communists/marxists/revolutionaries/muslim terrorists who want to enslave us and subject us to a boot on our neck. Organize and fight smart. Military personnel, police, fightfighters, etc., active and retired, we need your help and your knowledge, just to name a few groups.
Let’s get this done...God, Todd Beemer and those men and women who lost their lives on 9/11 and in every war in which Americans fought and died were couragous and brave. None of us wake up in the morning and say this is the day we will be couragous and brave. And neither did they....they just got up and got er’ done.
Stand up and fight, so that they did not give up their lives for nothing.
Brilliant question. I’d like to hear the answer from the government on that one too.
One gal I knew years ago had enough meds stored up to open up her own pharmacy. Sometimes I wish someone with common sense and a sense of budgetary constraint was in charge of Medicare and Medicaid. If non-citizens and people not entitled to benefits were eliminated from both (forcing their own countries and/or personal accountability to pay), that alone would save both millions of dollars, not counting obvious fraud that seems to persist.
One gal I knew years ago had enough meds stored up to open up her own pharmacy. Sometimes I wish someone with common sense and a sense of budgetary constraint was in charge of Medicare and Medicaid. If non-citizens and people not entitled to benefits were eliminated from both (forcing their own countries and/or personal accountability to pay), that alone would save both millions of dollars, not counting obvious fraud that seems to persist.
One gal I knew years ago had enough meds stored up to open up her own pharmacy. Sometimes I wish someone with common sense and a sense of budgetary constraint was in charge of Medicare and Medicaid. If non-citizens and people not entitled to benefits were eliminated from both (forcing their own countries and/or personal accountability to pay), that alone would save both millions of dollars, not counting obvious fraud that seems to persist.
One gal I knew years ago had enough meds stored up to open up her own pharmacy. Sometimes I wish someone with common sense and a sense of budgetary constraint was in charge of Medicare and Medicaid. If non-citizens and people not entitled to benefits were eliminated from both (forcing their own countries and/or personal accountability to pay), that alone would save both millions of dollars, not counting obvious fraud that seems to persist.
It’s the source of injury exclusions on steroids !
The 96 HIPPA draft made source of injury a non-issue, they (insurance companies)couldn’t discriminate against injuries received from skiing, sky diving, horseback riding, contact sports and other “inherently dangerous” activities.
The final Clinton ‘rules’ stated insurers couldn’t deny you coverage for participation in those activities, they just don’t have to cover injuries received !
and you thought it was just about privacy.
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