Medicaid Expands Never Events To Lessen Costs and Medical Mistakes

Medicaid published a new rule recently expanding their list of “Never Events” to be aligned with Medicare’s and many states nonpayment policies. These “Never Events” are largely preventable and will now be denied nationwide should a health care professional or facility seek payment for a patient’s treatment. Unless it is documented during a patient’s admission, health care facilities will not be reimbursed by Medicare or be able to go after costs from the patient.

For example, the Centers for Medicare and Medicaid Services (CMS) said that an estimated 40-percent of hospital admissions were preventable when nursing home residents were put into their care, and 314,000 potentially avoidable hospitalizations and $2.6 billion in Medicare expenditures could have been saved. The updated list seeks to align Medicaid and Medicare policies, increase the quality of health care, and cut costs.

“These steps will encourage health professionals and hospitals to reduce preventable infections, and eliminate serious medical errors,” said Donald Berwick, administrator of the Centers for Medicare and Medicaid Services. “As we reduce the frequency of these conditions, we will improve care for patients and bring down costs at the same time.”

Big medical associations are concerned about the new rule. As a result, CMS is allowing states until July 2012 to implement the new policy and increase nonpayment to different types of health care facilities beyond the hospital setting and create their own “Never Events”. CMS wants to foster better coordination between nursing facilities and hospitals and gain better health outcomes in tandem with the current administration’s Partnership for Patients initiative.

Proponents of the new rule say that patients at long-term care, rehab, and outpatient facilities will benefit in time as states expand the ruling to these health care centers, and not just keep it hospital or nursing home focused. “Never Events” such as Stage III and IV pressure ulcers and
deep vein thrombosis (DVT) or a pulmonary embolism (PE) after a total knee replacement or hip replacement will no longer be covered, barring pediatric or obstetric exceptions.1

To prevent these types of “Never Events” health care professionals can contact an experienced compression therapy distributor to meet their patient’s needs. Vascular PRN is skilled in helping hospitals, nursing homes, surgery centers and other institutions get the best equipment at a great value. The company carries the top name brands for rent and for sale, and delivers nationwide. For DVT, they have a wide selection of foot, calf, and leg pumps and bariatric solutions too. For the prevention of pressure ulcers, they carry the new Skin IQ™ Microclimate Manager waterproof mattress cover to maintain a patient’s skin integrity and decrease nosocomial risk when used early on as part of the patient’s therapy on an existing pressure redistribution mattress. To learn more, visit www.vascularprn.com or call 800-886-4331.

Vascular PRN
601 S. Falkenburg Road, Suite 1-4
Tampa, FL 33619
[email protected]
800-886-4331

Knowing Your Patient’s Wound Type is Critical in Long-Term Care

600,000-plus people are diagnosed with leg ulcers each year, medical statistics show. Pressure ulcers are the most reported but healthcare professionals must be cautious to truly know the type of ulcer that a patient has. Knowing the signs of a venous stasis ulcer versus a bedsore, for example, is extremely important as long-term care providers help a wide range of patients.

“If we don’t take the time to really get to know each resident and their history, we won’t know the risk factors and won’t be able to prevent some of these wound problems in the first place,” said Dr. James Spahn. “Regardless of the wound type, it does really come down to education. Without it, we’re in trouble.”

An article in McKnight’s Long Term Care News advocates that healthcare professionals must be proactive with their patients and know their patient’s history, risk factors, and take a team approach to diagnose a wound correctly. The article cites how residents with venous stasis disease, lymphedema, and diabetic foot ulcers have to be very careful when it comes to wound care.

“What works on one [resident] will not necessarily work for everyone, even if it is the same type of wound with basically the same underlying etiology and comorbid conditions,” said Nurse Jackie Todd, who is also a clinical education specialist for Medline Industries, Inc. “In order to achieve quality healed outcomes in the shortest amount of time, we have to step back, look from that 10,000-foot vantage point, and take a common sense approach to wound care.”

One way to combat venous stasis ulcers is through the use of compression therapy devices. Mechanical compression therapy reduces venous stasis by promoting venous blood flow and fibrinolytic activity. The devices will help even after an ulcer is healed, as oftentimes the ulcers will reoccur throughout the patient’s lifetime. Many doctors recommend treatment for these types of ulcers that involve both local wound care and adequate mechanical compression therapy.