Pressure Ulcer Medicare Payment
Pressure to Change
“A discussion on the ethics and finances of Medicare’s refusal to pay for pressure ulcers that develop in a hospitalized patient.”
“Pressure to Change”
Medicare like all health insurers is constantly looking for ways to avoid paying for unnecessary medical care. The latest attempt sounds perfectly reasonable until you consider who will bear the burden.
Problem: Last year federal centers for Medicare and Medicaid Services announced that they would no longer reimburse hospitals for treatment of new pressure sores in Medicare patients. The ruling, known as the Inpatient Prospective Payment System (IPPS) final rule, adopts a new Medical Severity Diagnoses Related Group (MS-DRG) classification system that expands the current number of DRGs from 538-745, with weighing factors that will be phased in over a 2 year period.
What does this all mean: Under the new payment plan, pressure ulcers present on admission will qualify for a higher reimbursement ONLY if the pressure of Stage III or IV ulcer is noted in the medical record within 2 days of inpatient admission. Anything identified after that initial admission period will not be eligible for additional reimbursement. Medicare’s rationale is that by refusing to pay for a “never event” it will reduce the number of mistakes. They claim that the “never event” is a mistake so easy to prevent that it should never happen.
Don’t have Medicare and think this does not affect you, well it does, most private insures usually adopt Medicare rules eventually. However, Medicare still pays for errors on wrong site surgeries which seem like a “never event” that should top the list as PREVENTABLE!
What are pressures and are they really preventable: The medical term Decubitus Ulcer, Decubitus mean’s “lying down” simply implies only a single etiology for these lesions, yet their pathogenesis also includes, at least, friction, shear force, moisture, temperature elevation, sensory impairment and oxygen
“A discussion on the ethics and finances of Medicare’s refusal to pay for pressure ulcers that develop in a hospitalized patient.”
“Pressure to Change”
Medicare like all health insurers is constantly looking for ways to avoid paying for unnecessary medical care. The latest attempt sounds perfectly reasonable until you consider who will bear the burden.
Problem: Last year federal centers for Medicare and Medicaid Services announced that they would no longer reimburse hospitals for treatment of new pressure sores in Medicare patients. The ruling, known as the Inpatient Prospective Payment System (IPPS) final rule, adopts a new Medical Severity Diagnoses Related Group (MS-DRG) classification system that expands the current number of DRGs from 538-745, with weighing factors that will be phased in over a 2 year period.
What does this all mean: Under the new payment plan, pressure ulcers present on admission will qualify for a higher reimbursement ONLY if the pressure of Stage III or IV ulcer is noted in the medical record within 2 days of inpatient admission. Anything identified after that initial admission period will not be eligible for additional reimbursement. Medicare’s rationale is that by refusing to pay for a “never event” it will reduce the number of mistakes. They claim that the “never event” is a mistake so easy to prevent that it should never happen.
Don’t have Medicare and think this does not affect you, well it does, most private insures usually adopt Medicare rules eventually. However, Medicare still pays for errors on wrong site surgeries which seem like a “never event” that should top the list as PREVENTABLE!
What are pressures and are they really preventable: The medical term Decubitus Ulcer, Decubitus mean’s “lying down” simply implies only a single etiology for these lesions, yet their pathogenesis also includes, at least, friction, shear force, moisture, temperature elevation, sensory impairment and oxygen
Cited: Fleck CA. Pressure ulcers: risks, causes, and prevention. Extended Care Product News. 2005;105:32-40. Available at: http://www.extendedcarenews.com/article/4968. Accessed February 6, 2008. Parish LC, Witkowski JA. Controversies about the decubitus ulcer. Dermatol Clin North Am. 2004;22:87-91. National Pressure Ulcer Advisory Panel. Updated Staging System, 2007. Available at: http://www.npuap.org/pr2.htm. Accessed February 23, 2008. National Pressure Ulcer Advisory Panel. Pressure ulcers in America: prevalence, incidence and implications for the future. Adv Skin Wound Care. 2001;14:201-215. Garber SL, Rintala DH. Pressure ulcers in veterans with spinal cord injury: a retrospective study. J Rehabil Res Dev. 2003;40:433-441. Department of Health and Human Services, Centers for Medicare and Medicaid Services. Proposed Changes to the Hospital Inpatient Prospective Payment Systems and Fiscal Year 2009. Published April 30, 2008. Available at: http://www.cms.hhs.gov/AcuteInpatientPPS/IPPS/itemdetail.asp?filterType=none&filterByDID=0&sortByDID=4&sortOrder=descending&itemID=CMS1209719&. Accessed April 30, 2008. Krapfl L, Mackey D. Medicare changes to the hospital inpatient prospective payment systems: commentary on the implications for the hospital-based wound care. J Wound Ostomy Continence Nurs. 2008;35:61-62. Available at: http://www.nursingcenter.com/library/JournalArticle.asp?Article_ID=767823. Accessed February 25, 2008.