Each year, Medicaid pays about $7 million to doctors and hospitals for certain preventable mistakes such as operating on the wrong body part or accidentally leaving a foreign object in a patient after surgery.

That’s supposed to stop under a new federal rule.

The U.S. Department of Health and Human Services issued a rule June 1, 2011, aimed at prohibiting payments for these so-called “never events.” Twenty-one states already have adopted such a policy. The federal rule — created under the federal health care reform law — takes effect July 1, 2011, but states have until July 1, 2012, to put it into practice.

“These steps will encourage health professionals and hospitals to reduce preventable infections and eliminate serious medical errors,” Donald Berwick, administrator of the federal Centers for Medicare & Medicaid Services, says in a news release.

Medicaid is a program for the poor and disabled; it’s jointly financed by federal and state agencies. Medicare, a federal health care program for the elderly, has had a similar rule in place since 2008.

The new rule is projected to save Medicaid about $35 million over five years, according to the Department of Health and Human Services. The savings for Medicare have been much more — about $20 million a year.

In a March 2011 letter to Berwick, the American Medical Association said it “continues to work aggressively to improve quality and efficiency for patients, but simply not paying for complications or conditions that, while extremely regrettable, are not entirely preventable, is a blunt approach that is not effective or wise for patients of the Medicare or Medicaid program.”

Here is the complete list of “health-care acquired conditions” that will prompt no payments from Medicaid:

• Foreign object (such as a surgical sponge) that remains after an operation.

• Surgery on the wrong patient, the wrong surgery on a patient or surgery in the wrong place on the body.

• Air embolism (blockage of an artery or vein by an air bubble).

• Blood type incompatibility.

• Third- and fourth-stage pressure ulcers.

• Falls or trauma resulting in fractures, dislocations, intracranial (skull) injuries, “crushing” injuries, burns or electric shock.

• Presence of poor glycemic (blood sugar) control that results in diabetic ketoacidosis (when the body can’t use glucose as a fuel source); nonketotic hyperosmolar and hypoglycemic comas (two potentially deadly types of diabetic coma); and two types of secondary diabetes (with ketoacidosis and with hyperosmolarity).

• Catheter-associated urinary tract infection.

• Catheter-associated infection related to the blood vessels.

• Surgical infection following coronary artery bypass, bariatric (obesity) operation, laparoscopic gastric bypass operation, laparoscopic gastric restrictive operation or gastroenterostomy (surgical formation of a new opening between the stomach and the intestine).

• Surgical infection following orthopedic procedures involving the spine, neck, shoulder or elbow.

• Deep vein thrombosis (formation of a blood clot in a deep vein) and pulmonary embolism (sudden blockage of a major blood vessel in a lung) following a total knee replacement or a hip replacement.



 SOURCE: Kevin Lyons with permission from insurancequotes.com.