Posted 11:33AM EST, May 05, 2008
Cutting payments for "Never Events"
Medicare has cut payments for certain problems that occur in hospitals in an effort to improve quality of care. Currently, Medicare is proposing new cuts in payments for nine more items, leading some health care providers to question how appropriate the new items are.
The Wall Street Journal Health Blog reports that health care providers and associations are challenging a new list of proposed cuts in Medicare payments for "Never Events". Things like Legionnaire's disease, ventilator-associated pneumonia and seven other events are termed "Never Events" to emphasize the idea that they should never occur. The rationale behind the cuts, the report reveals, is that preventable errors should not be covered by the government or private insurers.
However, the WSJ Health Blog says the American Hospital Association and the American Medical Association are among those questioning how attainable the proposed goals are:
Sources: CMS, WSJ Health Blog, AHRQ, JAMA.
However, the WSJ Health Blog says the American Hospital Association and the American Medical Association are among those questioning how attainable the proposed goals are:
Nancy Foster, the American Hospital Association’s VP for quality and patient safety policy, took issue with whether there’s strong evidence that two items on the new list, delirium and disease associated with clostridium difficile infection, are preventable, according to American Medical News, published by the AMA. “There has to be good evidence that someone has been able to employ a strategy that has driven incidence to near zero,” she said. “Otherwise, it’s just a wish.”A commentary in the December 19, 2007 JAMA by physicians Heidi L. Wald and Andrew M. Kramer offered an acknowledgement of the difficulties organizations will face in meeting the new standards:
Avoiding reasonably preventable harms such as catheter-associated UTIs is a major challenge for the health care enterprise. All too often, clinicians, hospitals, and payers conclude that some harms are part of the price of doing business. But in many cases they are not. When properly designed, financial incentives should provide rewards for desired clinical outcomes, not hospital-acquired harms. Such incentives will promote a commitment to reducing hospital-acquired harms such as catheter-associated UTIs. The answer to the question of whether to pay for preventable harms resulting from medical care may be found in a corollary of the classic dictum: "First, do not pay for harm."The new proposed codes would go into effect October 1, 2008.
Sources: CMS, WSJ Health Blog, AHRQ, JAMA.
