AMA and AAMC oppose expanding hospital no-pay list

The Centers for Medicare & Medicaid Services has proposed denying payment for treating certain conditions after electronic cardiac device implants and venous catheterization.

By Charles Fiegl amednews staff — Posted July 9, 2012

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Physicians and medical schools have come out against the further expansion of a Medicare no-payment policy for hospital-acquired conditions that are deemed preventable.

The Centers for Medicare & Medicaid Services proposed strengthening its policy on hospital-acquired conditions in an April regulation. CMS is seeking to add acquired conditions stemming from cardiac implantable electronic device surgeries and iatrogenic pneumothorax with venous catheterization.

In 2007, CMS finalized its first version of the no-payment rule for hospital-acquired conditions. Hospitals do not receive increased payments for treating 10 conditions unless they are documented and coded as present upon admission. The facilities still would be paid for care based on the primary reason for the hospital stay.

The American Medical Association reiterated its opposition to the policy in a June 20 comment letter to CMS. The Association opposes nonpayment in any patient setting for conditions without the opportunity to demonstrate that they were not reasonably preventable.

“There is strong, unequivocal disagreement with CMS throughout the medical community & that many inpatient [hospital-acquired conditions] are reasonably preventable,” the letter stated. “Some patients, particularly high-risk, co-morbid individuals, may still develop the conditions” on the list.

CMS can add conditions to the no-payment list if the services needed to treat them are high-cost or high-volume, result in a higher payment when present as a secondary diagnosis, and reasonably can be prevented.

More than 500,000 cardiac electronic devices are implanted each year. A majority of these surgeries are for Medicare-age beneficiaries. “CIED therapy reduces morbidity and mortality in selected patients with cardiac rhythm disturbances,” the proposed rule states. “However, the benefit of CIED therapy is somewhat reduced by complications following device placement, including infections.”

But the Medicare agency also notes that there were only 859 such infection cases in 2011, which does not qualify as a high-volume condition, the AMA letter said.

Iatrogenic pneumothorax can occur during diagnostic or therapeutic interventions involving catheterization, CMS said.

The Assn. of American Medical Colleges opposes adding both new categories, because Medicare has included or has proposed to include the preventable conditions as measures under hospital value-based purchasing programs.

“Therefore, inclusion of these conditions in the [hospital-acquired conditions] program would be an unnecessary duplication,” Darrell G. Kirch, MD, AAMC’s president and CEO, wrote in a June 25 letter that included comments on a wide range of hospital issues. “Additionally, these measures represent complications of care rather than true never events.”

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Medicare’s hospital-acquired condition no-pay list

The Centers for Medicare & Medicaid Services has proposed adding two new categories — conditions stemming from cardiac implantable electronic device surgeries and iatrogenic pneumothorax with venous catheterization — to its hospital-acquired condition nonpayment policy. The conditions that Medicare currently will not pay hospitals to treat are:

  • Foreign object retained after surgery
  • Air embolism
  • Blood incompatibility
  • Stage III and IV pressure ulcers
  • Falls and trauma
  • Manifestations of poor glycemic control
  • Catheter-associated urinary tract infection
  • Vascular catheter-associated infection
  • Surgical site infection after coronary artery bypass graft, bariatric surgery for obesity and certain orthopedic procedures
  • Deep vein thrombosis/pulmonary embolism after certain orthopedic procedures

Source: Centers for Medicare & Medicaid Services (link)

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