Medicaid patients, beware!

This year, CMS (the centers for Medicare and Medicaid Services) made a public statement that physicians, nurse practitioners, clinics and hospital facilities will not be reimbursed any more for treating medical problems, injuries, or readmissions when they should were avoidable.  This is in keeping with a section of the Affordable Care Act where states are banned from making Medicaid reimbursements to healthcare providers for services rendered to patients for medical problems determined to be “reasonably preventable.”

The final ruling went into effect the first of this month although the tate of implementation for the states is until July 2012.

This follows on the heals of a ruling in 2008 where Medicare discontinued reimbursement to hospitals for treatment of sickness, acute infections and medical conditions that were iatrogenic or acquired in the hospital.

The current Medicaid list reflects the Medicare list with such notables as fractures and dislocations from falls, head ventolin no prescription online pharmacy uk ventolin australia injuries, surgical site infections, burns, shocks and reactions from poor control of  blood sugar levels.

Private insurers have taken note of Medicare’s policy to refuse payment for preventable events and are now implementing these policies as well.

So, the questions that I am posing to you are the following:

  • Who is who is supposed to pay for treatment of these patients?  If the patient gets sick while in the hospital; should the doctors be penalized?
  • If the patient has a relapse and needs readmission, is it the hospital’s fault? Will the patient stay home knowing that a bill will be generated that the individual cannot afford (even if it involves a threat to the public?)
  • If a patient falls while in the hospital going to the restroom, will treatment be denied when unaffordable?

While the government is scrambling to make healthcare more affordable, there are important questions that need to be viewed…AND ANSWERED!