The CMS should not continue to expand their never-pay list lest they be accused of practicing Medicine.
It makes sense to say that if somebody has the wrong leg amputated, they should not get paid. That is a big “oops” that every member of the healthcare team should prevent. But once the CMS crosses over to problems that are questionably preventable, they risk causing more harm than good.
For example: a patient developing a blood clot after surgery. The cause of this is complex and not fully understood. In fact, the entire conceptual framework behind how blood clots form in the human body is currently undergoing a massive shift. Science may just show that the combination of a big surgery plus somebody’s genetic predisposition may reliably lead to the formation of blood clots.
Why does this matter? Blood clots are still bad. The answer is that this type of incentive creates a terrible moral hazard.
If you are not going to get paid for something you have no control over, are you going to admit it is even there?
Here is what CMS announced on July 31st:
In last year’s final rule, CMS listed eight preventable conditions for which it would not make additional payments. In this year’s proposed rule, CMS identified nine potential categories of conditions, but based on public comments, is finalizing three of these. The new additional conditions in this year’s final rule include:
· Surgical site infections following certain elective procedures, including certain orthopedic surgeries, and bariatric surgery for obesity
· Certain manifestations of poor control of blood sugar levels
· Deep vein thrombosis or pulmonary embolism following total knee replacement and hip replacement procedures
Good job, CMS, on putting your foot down on the craziness of wrong-site surgeries or giving the wrong blood to a patient.
But do not make the mistake of thinking you save the world through such mechanisms. In fact, the worse thing that can happen is that we don’t diagnose blood clots, infections, or abnormal glucose levels. Ignoring these conditions has definitely been shown to lead to bad outcomes.
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