The Centers for Medicare & Medicaid Services issued a final rule Wednesday that will reduce or prohibit Medicaid payments to doctors, hospitals or other healthcare providers for services that resulted in preventable healthcare-acquired illness or injury.
This rule, which was intended to lower states’ Medicaid costs, is based on successful Medicare policies placed on hospitals. According to CMS, the rule better aligns Medicare and Medicaid payment policy, while offering states some flexibility. States will be allowed to expand the list of preventable conditions and identify which healthcare settings Medicaid may or may not deny payment. Preventable conditions include falls and trauma, blood incompatibility, catheter-associated urinary tract infections, pressure ulcers, poor glycemic control and others.
“These steps will encourage health professionals and hospitals to reduce preventable infections, and eliminate serious medical errors. As we reduce the frequency of these conditions, we will improve care for patients and bring down costs at the same time,” said CMS Administrator Donald M. Berwick, M.D.
Dan Mendelson, CEO of the healthcare industry consultancy, Avalere Health, expects the rule to have a big impact on long-term care providers in the long run, although LTC providers are not explicitly mentioned in the rule.
“This rule does not force the states to engage with post-acute providers, but they will. It’s just a matter of when,” Mendelson told McKnight’s. “States are now empowered. The only way to achieve certain quality metrics is to engage acute-care settings and long-term care. If hospitals want fewer patients with pressure wounds, they have to have fewer patients with them coming in from post-acute settings. At some point the states will want to apply these metrics to post-acute care.”
