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Medicaid Will No Longer Pay Hospitals for Preventable Illnesses or Injuries

The National Journal reports, “Medicaid will no longer pay hospitals or doctors for certain preventable illnesses and injuries, such as operating on the wrong body part, the Health and Human Services Department said Wednesday.” In a statement, Donald Berwick, administrator of the Centers for Medicare and Medicaid Services, said, “These steps will encourage health professionals and hospitals to reduce preventable infections, and eliminate serious medical errors.” The Journal points out that Medicare “already has such a policy — one widely recommended by health care experts as a way to help prevent expensive and deadly errors.”

“Now this concept will be extended to Medicaid,” CQ reports. “Under the healthcare law (PL 111-148, PL 111-152), the curb on payments for preventable conditions must also apply to Medicaid.” In other words, “states won’t be allowed to pay providers including hospitals, doctors and other health care organizations if patients develop conditions that are deemed reasonably preventable.”

Kaiser Health News reported, “Currently, about 21 states have such a nonpayment policy,” but “the 2010 federal health law, in effect, expands the ban nationwide. The rule published [yesterday] gives states until July 2012 to implement it.” However, some medical groups have reservations about this policy. Kaiser Health News quoted written comments made by Michael Maves, MD, CEO of the American Medical Association, to the CMS three months ago. Maves wrote, “Simply not paying for complications or conditions, that, while extremely regrettable, are not entirely preventable, is a blunt approach that is not effective or wise for patients or the Medicare or Medicaid program.”

Writing in the Forbes “Health Dollars” blog, David Whelan focused on possible unintended consequences of the new rule proposed by the CMS that “would modify the Inpatient Prospective Payment System.” Whelan pointed out that “the new payment plan assumes that changing a whole industry is as simple as turning a few knobs and pushing a few buttons on the Medicare dashboard. Implementing such a scheme will be extremely difficult, possibly unfair and will most definitely increase the cost of health care rather than save money.” Whelan contended that Medicare currently does not have the necessary experience to make clinical judgments affecting patients. He also voiced concern that hospital systems would have to merge as a result of the proposed rule, thereby setting up “powerful health care oligarchies.”

From the American Association for Justice news release.

Bob Kraft

I am a Dallas, Texas lawyer who has had the privilege of helping thousands of clients since 1971 in the areas of Personal Injury law and Social Security Disability.

About This Blog

The title of this blog reflects my attitude toward those government agencies and insurance companies that routinely mistreat injured or disabled people. As a Dallas, Texas lawyer, I've spent more than 45 years trying to help those poor folk, and I have been frustrated daily by the actions of the people on the other side of their claims. (Sorry if I offended you...)

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