Medicare "No-Pay Rule" for Ten Hospital-Acquired Conditions of Importance to AAs

Starting October 1st, the Centers for Medicare & Medicaid Services (CMS) initiates rules that limit claims for 10 hospital-acquired, in-patient conditions. According to a CMS press release, this is an aggressive move to encourage greater patient safety and to reduce the number of "never events" - preventable medical errors that result in serious consequences for the patient. These never events also result in additional costs to Medicare and Medicaid in order to treat the consequences of the errors. CMS sees this as a reflection of a strong commitment that these events should be prevented. AMA delegates feel that the conditions on the list are not always preventable, even if evidence-based guidelines are followed.

Some of the conditions on the no-pay list are directly related to patient care that occurs in the operating room. AAs should familiarize themselves with this list that includes vascular catheter-associated infection, foreign object obtained after surgery, blood incompatibility, and certain manifestations of poor blood sugar control. Most facilities or departments of anesthesiology have protocols or policies and procedures for checking blood prior to its administration to a patient, blood glucose monitoring, and sterile technique for insertion of various in-dwelling catheters. AAs should seek out these policies and protocols to be sure that they are in compliance. If these policies and protocols do not reflect the most current study-based recommendations, then AAs should be pro-active in bringing this to the attention of the appropriate person or committee.

To learn more about the CMS "no-pay" list go to http://www.ama-assn.org/amednews/2008/08/25/gvl10825.htm. This content will be viewable for approximately 90 days or until the end of November 2008.