skyrocketing cost of healthcare, Medicaid

Medicaid to Cease Payment for Some Medical Mistakes


By Anne-Marie Botek, June 24, 2011

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To manage the skyrocketing cost of healthcare, Medicaid, like its partner program, Medicare, plans to cease reimbursing hospitals for ‘never events' and the complications that arise from them.

A ‘never event,' as defined by the U.S. Department of Health and Human Services (HHS), is a mostly preventable, alarming medical mistake. Examples include surgery performed on the wrong body part; a patient who commits suicide in a health-care facility; and patient kidnapping.

The Centers for Medicare and Medicaid Services, a sub-agency of HHS, has projected that this initiative will slash $35 million from Medicaid's projected payouts over the next five years—but it will barely make a dent in the $364 billion Medicaid budget. The new rule becomes effective on July 1, 2012.

Medicaid's move has rekindled the debate that was ignited when Medicare announced in 2008 that they would cease payment for ‘never events.'

The American Medical Association (AMA) is concerned that Medicaid's decision may "have serious unintended consequences," including lower-quality care for Medicaid recipients, and may actually increase costs rather than reduce them.

In a March 2011 letter to Donald Berwick, an administrator for CMS, AMA Executive Vice President Michael Maves outlined why he thought the rule will be bad for both health-care providers and patients.

Health-care providers will be exposed to increased liability, which could lead to a "Catch 22" situation where physicians, wary of lawsuits, withhold treatments that have "unpredictable" consequences. For example, doctors may decide not to prescribe some antibiotics that are given post-operatively to prevent certain kinds of infections but can sometimes allow others to flourish.

The result, he wrote, "will place Medicaid patients at further risk of reduced access to care and increased financial costs, with unproven benefits, on an already over-stretched Medicaid program."

HOW MEDICAID EFFECTS FAMILIES

Letter

Protecting Medicaid

Published: June 23, 2011




ShareTO the editor:

It is a hopeful sign that 41 senators have spoken out in favor of sustaining the Medicaid program (“Signs of Life Spotted in the Senate,” editorial, June 19).

The middle class should not be lured into thinking that Medicaid is a program for the poor. Medicaid provides an important safety net for middle-class families when parents and grandparents need long-term services and supports.

At a cost of as much as $100,000 a year, it doesn’t take long to wipe out a lifetime’s worth of savings. Without Medicaid, adult children would have to take on these costs — often just at the time they are digging deeper to pay for college for their children.

And severely cutting Medicaid will most certainly hurt our nation’s ability to provide health coverage to America’s poor — including low-wage, direct-care workers who provide long-term services and supports but ironically often do not have health coverage themselves.

Protecting Medicaid is essential to the economic security of the vast majority of Americans.

STEVE EDELSTEIN
Bronx, June 20, 2011

The writer is national policy director of PHI, formerly the Paraprofessional Healthcare Institute.

MEDICAID FINANCING

Medicaid is financed jointly by the federal government and the states. When a state wants to modify its Medicaid program, it must amend its state Medicaid plan. The changes are subject to federal review and approval.