Starting July 2012 Medicaid will stop paying for preventable hospital mistakes, called “never events,” including operations on the wrong body part, infections from surgery and incorrect blood transfusions.
Medicaid is a joint state-federal program for the poor and disabled.
The changes are being made in an effort to reduce avoidable mistakes hospitals make, improve patient care, and cut spending from the Medicaid program. Under the rule, Medicaid money can’t be used to pay doctors and hospitals for things that “result from certain preventable health care-acquired illnesses or injuries,” the officials said.
Currently, about 21 states already have this nonpayment policy. The 2010 federal health law essentially expands the ban nationwide.
Some physician groups and hospitals are hesitant about the changes and have concerns that this approach is ineffective for those on Medicare and Medicaid.
Cindy Mann, director of Medicaid, said on MSNBC that the policy would help improve patient care and reduce costs in the $364 billion program. “All (health care) payers are looking to gain better value for the dollars they spend and Medicaid is no different,” she said.
But the savings that will come from the changes are relatively insignificant. According to the proposed rule, Medicaid will only save $35 million over the next five years by stopping funding for these medical mistakes.
Some of the preventable condition that Medicaid will no longer pay for include:
- Foreign Object Retained After Surgery,
- Air Embolism,
- Blood Incompatibility,
- Stage III and IV Pressure Ulcers,
- Falls and Trauma,
- Fractures,
- Dislocations,
- Intracranial Injuries,
- Crushing Injuries,
- Burns, and
- Electric Shock
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