Who Will Benefit from CMS's No-Pay Policies?

The Centers for Medicare and Medicaid Services announced increasing the number of conditions for which it will no longer reimburse. The original policy included 8 conditions: foreign object retained after surgery; air embolism; blood incompatibility' Stage III and IV pressure ulcers; falls and trauma; catheter-associated urinary tract infection; vascular catheter-associated infection; and surgical site infection after coronary artery bypass graft. Three new conditions to be added include: surgical-site infections following certain orthopedic and bariatric surgeries; certain manifestations of poor control of blood sugar levels; and deep-vein thrombosis or pulmonary embolism following total knee and hip replacements.

It is no surprise that the American Hospital Association does not agree with any of these conditions. If these no-pay conditions are imposed, will it really lead to better patient care? Will it prevent infections or other "preventable" conditions? As a result of non-payment for these sometimes unpreventable outcomes, what will be the impact to the healthcare delivery entity? Will this practice lead to a trickle-down to the end user; the patient? How will this impact clinical practice patterns? Will the increase in expense for care be moved to the front end of a hospital visit as more tests are ordered?

This is something we all should be keeping on our radar screens.

Carole La Pine, MSA, CPMSM, CPCS