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Newspapers praise CMS' new no-pay policy

Quality Improvement Monitor, October 10, 2008

Editorials in newspapers across the nation, including The New York Times, are lauding CMS’ new policy to stop paying for 10 hospital-acquired conditions, a rule that went into effect October 1.

“In theory, Medicare is not supposed to pay for such mistakes right now, as they are never reasonable and medically necessary,” the Times editorial said. “But Medicare is wisely seeking a national policy to ensure uniform payment decisions. That is a small but welcome step toward stopping doctors, not just hospitals, from making money off their errors.”

The 10 reasonably preventable events CMS will no longer pay for include:

  • Certain manifestations of poor control of blood sugar levels
  • Deep vein thrombosis or pulmonary embolism following total knee replacement and hip replacement procedures
  • Serious preventable event—retained object after surgery
  • Serious preventable event—air embolism
  • Serious preventable event—blood incompatibility
  • Catheter-associated urinary tract infections
  • Pressure ulcers
  • Vascular catheter–associated infection
  • Patient falls
  • Surgical site infection -- mediastinitis after coronary artery bypass graft surgery, bariatric surgery and certain orthopedic procedures

    The new no-pay policy, expected to save CMS $21 million annually, will not reimburse patients if they acquire the condition in the hospital and it puts them in a higher-paying diagnostic related group (DRG). However, many Medicare patients are elderly and have many co-morbidities, so they may likely be in the higher DRG anyway.

    For more information, click here.

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