New CMS payment, what Hospitals are not reimbursed for:

Published

On October 1, 2008, the Centers for Medicare and Medicaid Services (CMS) ceased reimbursing Medicare- and Medicaid-certified hospitals for 10 conditions, which it says are preventable, unless the conditions are present on admission (POA). POA is defined as a condition that's present at the time the order for inpatient admission occurs, including conditions that develop during an outpatient encounter, such as in the ED or during observation or outpatient surgery. If a patient develops any of the 10 hospital-acquired conditions (HACs), the costs to treat the condition will be paid by the healthcare provider.

What do you need to know about these reimbursement changes and what can you do, as a nurse, to help ensure your facility isn't adversely affected? Get the facts here.

The link shows the 1O conditions which are not covered once a patient is hospitalized.

http://www.nursingcenter.com/library/static.asp?pageid=839474

Specializes in Telemetry.

I am not a nurse yet, but I do work in the healthcare finance industry.

It is true that CMS implemented this to cut costs. With this ruling, it will save the agency around $50+B per year--money that can be applied somewhere else. While it is true that some, if not all of the listed "never events" cannot be avoided, they hope that this will encourage hospitals to be more efficient operations-wise. How it will specifically affect the clinical operations I'm not exactly sure but it is a trend that is starting to catch on here and in Europe (pay for performance). The higher the satisfaction rate a facility gets, the more money they get.

And with the amount of money that we get from Medicare, believe me it's not even worth getting excited about. But the hospital still gets money somewhere else.

I am not a nurse yet, but I do work in the healthcare finance industry.

It is true that CMS implemented this to cut costs. With this ruling, it will save the agency around $50+B per year--money that can be applied somewhere else. While it is true that some, if not all of the listed "never events" cannot be avoided, they hope that this will encourage hospitals to be more efficient operations-wise. How it will specifically affect the clinical operations I'm not exactly sure but it is a trend that is starting to catch on here and in Europe (pay for performance). The higher the satisfaction rate a facility gets, the more money they get.

And with the amount of money that we get from Medicare, believe me it's not even worth getting excited about. But the hospital still gets money somewhere else.

I understand what you're saying here, but the problem is this: as working nurses we know that the brunt of the negative return from these brilliant rules will fall on our laps--hospital admin will immediately make all of these occurences a nursing issue. Your patient fell and hurt themselves? It wasn't because there wasn't enough staff, and you aren't allowed to use restraints or even siderails..you as the RN were just not monitoring your patient.. Your LOL who is on dialysis, TPN, and is NPO gets a decub? It's not cuz she was malnourished and just all jacked up to begin with..The nurse FOR SURE didn't turn her enough... So I guess from my perspective anyway, while I know there are some (maybe many) of these instances we could avoid, basically we are gonna get dumped on for ALL of them, whether we could have avoided them or not. And that sucks. :banghead:

Specializes in psych. rehab nursing, float pool.

Shelbias,

It is worth the excitement as what Medicare Medicaid does, the insurance industry will follow. This is what the concern is about. Our facilities are struggling as it is without the government and insurance agencies looking for away not to pay.

Think of it this way. I hire a contractor to remodel my home. Things to do not go as originally planned as my home is unique with its own unique flaws. Will the contractor allow me to not pay for the costs? Not. The expectation is however that we can treat all humans with expected outcomes and the outcome are a perfect hospital course with no complications.

In the "good old days" EVERYONE admitted to a hospital had a chest xray, CBC, UA AND (shoot, can't remember the other lab test). Seems the least now would be a UA on all adults!

Shelbias,

It is worth the excitement as what Medicare Medicaid does, the insurance industry will follow. This is what the concern is about. Our facilities are struggling as it is without the government and insurance agencies looking for away not to pay.

Think of it this way. I hire a contractor to remodel my home. Things to do not go as originally planned as my home is unique with its own unique flaws. Will the contractor allow me to not pay for the costs? Not. The expectation is however that we can treat all humans with expected outcomes and the outcome are a perfect hospital course with no complications.

Medicare provides cover for private insurers. Regardless of how crazy, if the government does it, they can cite that as evidence to support following along.

As the feds move further into health care, the result will be more and more redundant paperwork, even less time w/Pts and poorer quality of care for all.

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