CMS Reimbursement Rules
The Centers for Medicare and Medicaid Services (CMS) stopped the reimbursements of complications which occur during patient hospitalization as from 2008 (McNair, Luft & Bindman, 2009). These complications are referred to as never events. The never events are preventable errors affecting hospitalized patients and they mostly occur due to negligence or failure to adhere to the set guidelines (Stone et al., 2010). Initially, the physician’s reimbursement model was fee-for-service. This involved paying them for their services and focusing on quantity instead of the quality of care and its outcomes. Reports indicated that medical errors were prevalent and they were costing the healthcare system a substantial amount of money every year (Stone et al., 2010). Because of the fee-for-service model, physicians were not keen to adhere to the set guidelines in order to avoid errors since they were paid based on quantity (McNair et al., 2009).
In order to reduce never events, a pay-for-performance reimbursement model was proposed whereby physicians would be paid depending on the outcomes of their treatments. As a result, CMS changed its reimbursement policy and stopped reimbursing hospitals for a number of preventable errors, referred to as never events (Stone et al., 2010). Examples of never events include falls, wrong-site surgeries, bedsores, wrong blood transfusions and infections resulting from catheters and surgeries. Hospitals are expected to bear the costs of never events and this is expected to compel them to adopt preventative measures to avoid the occurrence of these events (McNair et al., 2009). Hospitals are also expected to report on the satisfaction and experiences of their patients. These rules will ensure that patients in inpatient facilities will have better experiences and outcomes as hospitals will focus more on providing quality care to reduce medical errors instead of emphasizing on quantity (Stone et al., 2010).
References
McNair, P. D., Luft, H. S., & Bindman, A. B. (2009). Medicare’s policy not to pay for treating hospital-acquired conditions: the impact. Health Affairs, 28(5), 1485-1493.
Stone, P. W., Glied, S. A., McNair, P. D., Matthes, N., Cohen, B., Landers, T. F., & Larson, E. L. (2010). CMS changes in reimbursement for HAIs: setting a research agenda. Medical Care, 48(5), 433-439.
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