Medicare and a Never-Event Involving a Patient Transfer Case
To prepare for this Application Assignment, complete the following:
Review course texts in previous courses, such as the excerpts listed in this week's Optional Resources, or do online research to remind yourself of Medicare payment policies regarding "never events." Reflect on the ethical implications of Medicare's "never events" policy. What challenges would you expect to occur regarding who ends up paying for never-event conditions and the impact on quality of care?
Do online research to learn more about pressure ulcers. What causes them and what kind of care is required to treat them?
Review the consequences of false claims, as described in this week's Learning Resources.
Think through various ways in which an administrator could institute policies to help prevent or mitigate situations such as the one described above.
To complete this Application, address the following questions: the following Assignmentquestions:
What are the factors (e.g., timely and appropriate clinical services) that determine whether patients at risk for pressure ulcers receive proper skin care?
What does administration need to do to ensure that the hospital is not submitting claims for services for which payment is not available under applicable rules? Take into account the role of individuals who may want to become a whistleblower, or qui tam relator, under the False Claims Act.
Legally, how did CMS go about deciding that it would reduce reimbursement for hospital-acquired pressure ulcers and other conditions? Does this policy make sense to you? Why? Does the policy raise any ethical issues?
In what ways might an administrator alter systems to avoid the adverse conditions impacting payment, as described in this scenario? In particular, what if anything might a hospital administrator do regarding the skilled nursing facility from which this and other patients come?