Hospitals and physicians are criticizing the CMS for increasing the number of conditions for which Medicare will no longer reimburse when its policy for not paying for certain conditions goes into effect.
Its questionable whether the conditions are preventable and how they are to be recorded as present-on-admission is unclear, said Beth Feldpush, senior associate director for policy at the American Hospital Association. We did not agree with any of the conditions when they were proposed earlier this year, she said.
The original reimbursement policy included eight conditions. The three additional conditions are: surgical-site infections following certain orthopedic and bariatric surgeries; certain manifestations of poor control of blood sugar levels; and deep-vein thrombosis or pulmonary embolism following total knee and hip replacements.
But many of those conditions in the policy are not backed up by solid evidence as being completely preventable, according to J. James Rohack, a physician who is president-elect of the American Medical Association. Focusing on determining whether or not medical conditions exist when the patient enters the hospital will increase Medicare spending on tests and screenings with questionable benefit to patients, Rohack said in a written statement.
The final acute-care inpatient payment system 2009 rule included both the three hospital-acquired conditions and 13 more quality measures hospitals will be required to report on through the federal Hospital Compare Web site. (For a longer version of this story, please click here. Also see reader comments in our Daily Dialogue section.) -- by Jean DerGurahian