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Of Medical Payment Paradigm Shifts

Reimbursing Clinical Value – Not Medical Errors

By Dr. David Edward Marcinko; MBA, CMP™

[Editor-in-Chief] 

Dr David E Marcinko MBAAt our quarterly institutional print-guide: Healthcare Organizations [Financial Management Strategies], we strive to affect positive economic change in the enterprise-wide healthcare ecosystem and to optimize patient outcomes.  

And so, the Centers for Medicare and Medicaid Services (CMS) seismic decision not to reimburse “Never-Events” after October 1 2008, seems a wise one. Simply stated, in no other industry are frank mistakes reimbursed or tolerated by customers!  

Non-Payments for Never-Events 

Under the new policy, hospitals will stop requesting payment for the 27 National Quality Forum defined Never-Events listed in our last print issue – including wrong-site and wrong-patient surgery, patient death or disability due to wrong use of blood or blood products and medication errors – as well as related follow-up care to ameliorate such errors, if possible.

And, the list will likely expand going forward.  

Developing Trends 

More imminently as a vanguard, the Massachusetts Hospital Association (MHA)announced that it will no longer charge patients or health plans for treatments required to address NEs. The announcement makes it the second state whose hospitals have voluntarily made the pledge, following a September 2007 announcement by Minnesota’s HealthPartners – who not only requires its network hospitals to report errors to state governments – but also won’t let hospitals bill patients. 

Thus, an economic trend may be developing in the industry as a strategic competitive advantage. 

Future Pressures 

In the future, all covered entities may come under similar pressure as private insurers are gradually beginning to rule out payment for NEs. And, eventually as the trend evolves, hospitals and clinicians may end up eating the fee when more-minor errors occur; while allied healthcare providers, clinics and hospitals may adopt a proactive stand on the entirely logical issue well ahead of the deadline. 

Why Now? 

Q: Yet, why have public and private facilities and payers been indifferent to this basic business concept, until now?  

A: Perhaps the answer rests in human inertia. 

According to science historian Thomas Kuhn, such paradigm dislocations do not occur until defenders “can no longer evade anomalies that subvert the existing tradition.” To date, the suggestion that domestic medicine is inefficient and wastes money was merely an inert one.

But, the notion that it injures patients too; is not.  These “Never-Events”, defined as incidents that are not supposed to happen, spring more from human foibles than any evidence-based medical disaster. Of course, quality experts posit that public reporting of never-events is not meant to be punitive, but will promote correction among healthcare organizations and providers.

The Bigger Picture 

Nevertheless, the bigger epiphany lies in revising a certain mindset that existing medical payment schemes were not only appropriate, but somehow immutable to the laws of supply-demand.   The rise of consumer directed healthcare, retail clinics and concierge medical practices seem to suggest otherwise when the patient is fully informed.  

Only time will tell which “economic behavior” is prudent of course; although the absolute prohibition against clinical never-event outcome is clear, as we recall the admonishment “Primum non nocere”, or the fundamental medical precept of Hippocrates (ca. 460-ca.377 BC) to “First do no harm.”

Assessment

As insightful institutional subscribers to our print-guide – and readers of this complimentary companion personal economics blog – we trust that you and your hospital, medical clinic or healthcare entity will review, communicate, use and profit by this information.  

Moreover, let Healthcare Organizations: [Financial Management Strategies] reduce your resistance to future paradigm shifts that bespeak modernity, safety, economic utility, patient empowerment and common-sense. 

PS: Don’t forget to “review-read-rave and rant” online at this new companion web-log and communications forum. Your cogent thoughts, and informed opinions, are always appreciated. 

Conclusion 

Let us know what you think about this or any related issue? 

Speaker: If you need a moderator or a speaker for an upcoming event, Dr. David Edward Marcinko; MBA – Editor and Publisher-in-Chief – is available for speaking engagements. Contact him at: MarcinkoAdvisors@msn.com 

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2 Responses

  1. Folks,

    Under pressure from large private insurers, state governments and Medicare, hospitals around the country are now agreeing not to charge when they make certain medical mistakes – also called “never events” – because they shouldn’t happen.

    Please check out this related link:
    http://articles.moneycentral.msn.com/Insurance/InsureYourHealth/HospitalsWontGetToBillForErrors.aspx

    -Ann

    Like

  2. More on Shifting Paradigms

    Healthcare has become a claims-made market of change with intensified financial challenges and consolidation driven primarily by the evolving managed care industry and risk-shifting capitated reimbursement environment.

    Indeed, the paradigm shift in healthcare reimbursement, as described in this post, may signal a decrease in medical liability risk – or it may actually increase the risk.

    And so, for more info on this topic, please refer to this interesting post.
    Link: http://www.podiatrytoday.com/article/2408

    -Ann

    Like

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