New England Journal of Medicine · 2009 · 101 citations · 2 references
Health ProfessionsHealth PolicyHealth Services AdministrationHealthcare PolicyMedicare PolicyPatient SafetyHospital PolicyHospital ReimbursementPatient Safety PolicyReimbursement PolicyReimbursement RegulationSurgical ComplicationsDiagnosis-related Group BillingDiagnosis-related Group ReimbursementHospital Payment PolicyMedicare Coverage RulesMedicare Hospital RegulationMinimum Payment RulesPaymentPreventable Surgical Adverse Events
On September 1, 2008, Medicare eliminated a long-standing presumption in its payment rules that, since hospitals were doing everything possible to prevent complications of treatment, taxpayers and patients should primarily bear the average cost consequences when complications occurred. A 2006 law, meant to motivate hospitals to accelerate improvement of patients' safety, constrains hospitals' ability to bill Medicare for a higher-paid diagnosis-related group when complications occur.1 The constraint applies only to hospital-acquired conditions deemed “reasonably preventable” through the use of evidence-based guidelines. These initially included eight complication categories: foreign objects left in the body after surgery, air emboli, infusion of incompatible . . .
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