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Others payors may follow CMS's 'no pay' lead

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Centers for Medicare and Medicaid Services (CMS)

Hospitals are still trying to get their head around new Medicare rules that will ban reimbursement for certain "preventable" conditions by late 2008. And that's enough to absorb for now.

The truth is, however, CMS's decision could be just the beginning. With Medicare blazing the trail, Medicaid is likely to quickly follow, as are private payors.  In Pennsylvania, for example, where error reduction is a major part of the state's reform efforts, officials already are saying Medicare's decision could trigger changes in their Medicaid program's payment policy. And private health plans, already under pressure from some employers not to cover preventable illness, will have a good excuse to follow suit.

To learn more about this trend:
- read this Philadelphia Inquirer article

Related Articles:
Business say 'no pay' for major mistakes. Report
Study: Wrong-site surgeries, close calls are common. Report

Comments

Now that there could be financial consequences for bed sores, hospitals will need to document carefully the presence of any such wounds (or sores) on admission and discharge. I do not know how nursing homes will be effected by this new payment policy, but it will be in their interest to document the presence of wounds on admission and discharge as well. Wounds and bed sores are a significant area of liability and the oversight will only become more stringent with this new policy in place.
Mark Singh MD www.clinicore.com

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