Medicare continues to battle implementation problems as it begins its new non-reimbursement policy for certain hospital-acquired conditions, according to a CMS official.
Coding and the definition of what conditions are reasonably preventable by providers are a challenge for the federal agency, said Thomas Valuck, a physician who is medical officer and senior adviser in the CMS Center for Medicare Management. Valuck participated in a panel discussion about payment models during the National Quality Forums annual policy conference in Washington.
The no-pay policy, which took effect this month, is designed to stop providers from being paid for care related to problems they created after a patient was admitted to a hospital. The CMS tracks whether a patient experienced a hospital-acquired condition through the use of its present-on-admission code hospitals must now use for all Medicare claims; however, coding limitations dont always catch when a claim is bumped into a higher payment group, Valuck said. A lack of precision in coding has been a hindrance to us.
In addition, the CMS would like to gather more research about evidence-based guidelines so it can strengthen the definition of a reasonably preventable condition, he said. Valuck made a distinction between the conditions on its list of events that will not be paid for and the list of never events endorsed by the NQF that several hospital associations and insurers agree should never happen in facilities. Our hospital-acquired conditions are not necessarily intended to be never events because that wasnt part of the criteria developed under the statute governing the new non-payment policy, Valuck said. -- by Jean DerGurahian