The CMS decision to end Medicare payments for preventable errors, injuries and infections is likely only the first phase in an industrywide change in how these conditions are reimbursed. Thats because many major insurers said they would likely follow suit in embracing similar policies to reduce expenses and improve quality.
But some payers seemed reluctant to adopt rules identical to the CMS and may instead roll out changes more gradually, or not at all.
Its not clear yet how insurers decision to follow the CMS lead will affect hospitals bottom line, but it could result in increased patient testing for treatable conditions upon admission, said Nancy Foster, vice president of quality and patient safety policy at the American Hospital Association.
We certainly hope insurers will look carefully at what Medicare has done and make wise choices for their patient populations, Foster said.
Many insurers said the CMS decision is a step in the right direction. Humana and WellPoint both said they were working with network hospitals to develop similar policies. These discussions are taking place on a regional level in several states, Foster said.
This is something we as a company agree with, said Jim Gavin, spokesman for WellPoint.
But WellPoint may not change reimbursement for all eight hospital-acquired conditions adopted by the CMS. The company plans to develop guidelines for a handful of events, Gavin said, but wouldnt elaborate.
Humanas program is in the early stages of development, said spokesman Ross McLerran.
Cigna Corp. and UnitedHealth Group are also evaluating the rule change, those companies said.
Under the final rule, which takes effect in October 2008, Medicare will no longer reimburse hospitals for the treatment of certain preventable conditions (Aug. 20, p. 10). The conditions are hospital injuries; surgical-site infections; pressure ulcers; and urinary tract infections and vascular infections that may result from improper use of catheters.
In addition, Medicare wont reimburse for three never events: objects left in the body during surgery, air embolisms and blood incompatibility.
Insurers hailed the rule change as another means to push for quality improvements by providers. Our immediate take is that we support CMS efforts, said Mark El-Tawil, president of the senior products division at Health Net.
Health Net has not completed an internal evaluation of how to implement the rule, but it could complement the insurers existing efforts to oversee and improve hospital care, El-Tawil said.
Right now we have nothing that would allow us to have a payment impact, he said of Health Nets quality initiatives. This could be a helpful tool.
Premera Blue Cross, a major Pacific Northwest insurer, said it wouldnt follow suit.
We arent making any moves in that direction, said Mark Stuart, Premera spokesman. We try to promote quality rather than go on the punitive end.