preventable errors

CMS struggling to roll out new no-pay policy

Anne Zieger — Fri, 17 Oct 2008 09:52:52 -0400

For about a year now, the hospital industry has been struggling to prepare itself for the rollout of Medicare's new policy under which it won't pay for some hospital-acquired conditions. Now, it appears that CMS itself is having a hard time dealing with the rollout of the new policy.

Managing and tracking coding issues, and deciding which conditions are "reasonably preventable," are proving to be difficult problems, admits Thomas Valuck, a physician who serves as medical officer and senior adviser in the CMS Center for Medicare Management. For example, CMS execs aren't sure how to detect when a condition that's coded as present on admission--a requirement under current Medicare rules--gets moved up into a higher payment group.

CMS is also working to improve its store of research on evidence-based guidelines, as execs aren't happy with the precision of their definition of reasonably preventable conditions, Valuck said.

To learn more about the status of CMS's no-pay policy:
- read this Modern Healthcare piece (reg. req.)

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KS Blue plan stops paying for preventable errors

Anne Zieger — Thu, 17 Jul 2008 12:35:38 -0400

Another health plan has announced that it will stop paying for complications arising from preventable errors by hospitals. This time, it's Blue Cross and Blue Shield of Kansas City, which stands as the state's largest non-profit health plan with about 900,000 beneficiaries. As of October 1, the plan will stop reimbursing hospitals for complications resulting from several conditions, including air embolisms introduced during surgery, objects left inside a patient during surgery, use of wrong blood type, pressure ulcers and infections from central vein catheters. But these could change: Executives said that they'll probably modify their list of non-reimbursable events as CMS does so.

While the new policy may force some hospitals to make changes in their financial policies, some hospitals are already on board with this approach. For example, the University of Kansas Hospital, HCA Midwest Health System and Children's Mercy Hospitals & Clinics have said that they support the Blue plan's initiative.

To learn more about this approach:
- read this Kansas City Business Journal article

Related Articles:
Aetna, WellPoint refuse payment for serious errors
Many MA hospitals waive charges for errors
MA Blue plan, state ban payment for medical errors
PA hospitals won't charge for 'never events'
MN hospitals won't charge for major errors

SPOTLIGHT: AMA says CMS 'no-pay' list is unrealistic

Anne Zieger — Mon, 30 Jun 2008 21:43:21 -0400

At its annual convention this year, the American Medical Association raised some serious objections to Medicare's new plan to stop paying for a list of up to 17 hospital-acquired conditions. Delegates at the convention said that the conditions on CMS's list aren't necessarily preventable, even if physicians are following evidence-based guidelines. They argue that CMS rules threaten to increase the practice of defense medicine and will ultimately expose physicians to additional lawsuits. Article