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CMS to stop paying for preventable errors in 2008

Quality Improvement Monitor, August 24, 2007

Medicare will stop paying the additional costs of treating preventable errors, injuries and infections that occur in hospitals beginning in October of 2008, a move CMS says could save lives and millions of dollars, The New York Times reported in a front-page story Sunday.

The rule says that beginning October 1, 2008, CMS will not pay for the following eight conditions, unless they are documented as present on admission:

  • Serious preventable event -- object left in surgery
  • Serious preventable event -- air embolism
  • Serious preventable event -- blood incompatibility
  • Catheter -- associated urinary tract infections
  • Pressure ulcers
  • Vascular catheter -- associated infection
  • Surgical site infection -- mediastinitis after coronary artery bypass graft surgery
  • Patient falls

    The information will not be used by CMS' claims processing systems until January 1, 2008, but that doesn't mean that hospitals don't have to report beginning October 1, 2007, according to Tom Valuck, MD, JD, director of the special program office of value-based purchasing for CMS.

    After January 1, 2008, CMS will send letters to hospitals reminding them they need to send the federal agency the documentation. Beginning April 1, 2008, claims submitted to CMS that don't document conditions present on admission will be returned to the hospitals - unpaid. Organizations will only receive their reimbursement if they resubmit their claims with the proper data and coding.

    "If a patient goes into the hospital with pneumonia, we don't want them to leave with a broken arm," Herb B. Kuhn, acting deputy administrator of the Centers for Medicare and Medicaid Services, told the Times. (For a comprehensive look at the new rule, read the September issue of HCPro's Quality Improvement Report.

    For more information, click here.

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