Feds Cut Medicaid Payments for Preventable Conditions



As of July 1, Medicaid will no longer pay heath care providers for preventable, health care–acquired injuries or illnesses.

The final rule, which implements a part of the Affordable Care Act, takes another step forward in reducing unnecessary health care costs, Dr. Donald M. Berwick, administrator for the Center for Medicare and Medicaid Services, said during a June 1 press briefing.

Provider-preventable conditions that will no longer be reimbursed include catheter-associated vascular infections, pressure ulcers, blood incompatibilities, air embolisms, and surgical site infections. Also on the list: providing the wrong surgery, wrong-patient surgery, or wrong surgical site, Dr. Berwick said.

The rule is based on similar measures already implemented under Medicare and independently by many states, Dr. Berwick said.

Currently, 27 states prohibit payment for health care–acquired conditions and 17 do not pay for preventable conditions, according to Cindy Mann, director of CMS’s Center for Medicaid, CHIP, and Survey and Certification.

The Washington State Medicaid program is currently considering ways to increase accountability-based payment systems, according to its chief medical officer, Dr. Jeffery Thompson, who spoke during the press briefing.

Dr. Thompson said the state has determined it could save as much as $100 million, or one-sixth of its budget, by eliminating 30-day hospital readmissions.

Ms. Mann pointed out that examples like these show that avoiding preventable health care costs will improve the quality of care without cutting back on care for those who need it.

Under the provision, states will have the flexibility to expand the list of conditions that will no longer be reimbursed, pending CMS approval. States also will have the option to implement the provisions between July 1, 2011 and July 1, 2012.

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