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Podiatry Reimbursement Paradigm Shifts

By Dr. David Edward Marcinko; FACFAS, MBA


At our quarterly institutional print-guide: Healthcare Organizations [Financial Management Strategies], we strive to affect positive economic change in the enterprise-wide healthcare ecosystem and to optimize patient outcomes www.HealthcareFinancials.com


And so, the Centers for Medicare and Medicaid Services (CMS) seismic decision not to reimburse “Never-Events” after October 1 2008, seems a wise one. Simply stated, in no other industry are frank mistakes reimbursed or tolerated by customers!  


Non-Payments for Never-Events 


Under the new policy, hospitals will stop requesting payment for the 27 National Quality Forum defined “Never-Events” – including wrong-site and wrong-patient surgery, patient death or disability due to wrong use of blood or blood products and medication errors – as well as related follow-up care to ameliorate such errors, if possible. And, the list will likely expand going forward.  


Developing Trends 


More imminently as a vanguard, the Massachusetts Hospital Association (MHA) announced that it will no longer charge patients or health plans for treatments required to address NEs. The announcement makes it the second state whose hospitals have voluntarily made the pledge, following a September 2007 announcement by Minnesota’s HealthPartners – who not only requires its network hospitals to report errors to state governments – but also won’t let hospitals bill patients. 


Thus, an economic trend may be developing in the industry as a strategic competitive advantage. 


Future Pressures 


In the future, all covered entities may come under similar pressure as private insurers are gradually beginning to rule out payment for NEs. And, eventually as the trend evolves, hospitals and podiatrists may end up eating the fee when more-minor errors occur; while allied healthcare providers, clinics and hospitals may adopt a proactive stand on the entirely logical issue well ahead of the deadline. 


Why Now? 


Q: Yet, why have public and private facilities and payers been indifferent to this basic business concept, until now?  


A: Perhaps the answer rests in human inertia. According to science historian Thomas Kuhn, such paradigm dislocations do not occur until defenders “can no longer evade anomalies that subvert the existing tradition.”


To date, the suggestion that domestic medicine is inefficient and wastes money was merely an inert one. But, the notion that it injures patients too; is not.  These “Never-Events”, defined as incidents that are not supposed to happen, spring more from human foibles than any evidence-based medical disaster. Of course, quality experts posit that public reporting of never-events is not meant to be punitive, but will promote correction among healthcare organizations and providers. Hence the importance of real, documented, and standardized informed consent.


The Bigger Picture 


Nevertheless, the bigger epiphany lies in revising a certain mindset that existing medical payment schemes were not only appropriate, but somehow immutable to the laws of supply-demand.   The rise of consumer directed healthcare, retail clinics and concierge medical practices seem to suggest otherwise when the patient is fully informed.  


Only time will tell which “economic behavior” is prudent of course; although the absolute prohibition against clinical never-events is clear, as we recall the admonishment “Primum non nocere”, or the fundamental medical precept of Hippocrates (ca. 460-ca.377 BC) to “First do no harm.”




And so, how many of these never-events are germane to podiatric medicine? Maybe too many! For example, how about wrong-site, wrong-extremity, wrong-foot, wrong-toe, and wrong-patient surgery; or patient death or disability due to wrong use of blood or blood products and medication errors – as well as related follow-up care to ameliorate such errors!



Let us know what you think about this or any related informed consent issue? 


Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko MBA is available for medical seminars or other speaking engagements. Contact: MarcinkoAdvisors@msn.com  or Bio: www.stpub.com/pubs/authors/MARCINKO.htm

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Related Information Sources:

Board Preparation: www.PodiatryPrep.com

Practice Management: http://www.springerpub.com/prod.aspx?prod_id=23759

Physician Financial Planning: http://www.jbpub.com/catalog/0763745790

Medical Risk Management: http://www.jbpub.com/catalog/9780763733421

Healthcare Organizations: www.HealthcareFinancials.com

Health Administration Terms: www.HealthDictionarySeries.com

Physician Advisors: www.CertifiedMedicalPlanner.com

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Written by Dr. Marcinko

July 15, 2008 at 1:46 am

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