Medicare Expands List of ‘No-Pay’ Hospital Conditions

The list of hospital treatments that Medicare won’t pay for is growing, but not by as much as the feds initially suggested it might.

The Centers for Medicare and Medicaid Services said last year it would stop paying to treat certain complications it said were preventable with good care. (We described the initial list in this post.) Earlier this year, CMS said it could add nine more complications to the list.

CMS said yesterday that after considering public comments, it was adding three conditions:

Blood clots in patients after surgery for knee and hip replacements
Surgical site infections after certain elective procedures, including some orthopedic surgeries and bariatric surgery
Certain major problems that result from failing to control blood sugar levels after a patient is hospitalized
It’s pretty easy to agree that Medicare shouldn’t be paying for preventable errors, such as leaving items inside patients during surgery (one of the conditions on the initial no-pay list). But there are arguments from some quarters that the new items on the list aren’t always preventable, and therefore don’t belong on the no-pay list.

For example, even with the best treatment, blood clots remain relatively common in patients after knee and hip replacements, according to the Society of Hospital Medicine, a national group of hospital-based docs. What’s more, the new rules could add incentives for hospitals to over-use blood thinners in an effort to drive rates down, Patrcick Torcson, who chairs the society’s performance and standards committee, told the Health Blog today.

On the other hand, the blood sugar-related conditions are appropriate for the no-pay list because “complications from uncontrolled blood sugars in diabetics can be reasonably prevented” in hospitalized patients, Torcson said.

Source: Health Blog(The Wall Street Journal)