Managed Healthcare Executive - November 2008 - (Page 25)

{ HOSPITALS AND PROVIDERS } fered to hospitals will be performancebased. For example, those may include the best and most improved hospital care programs, based on speci c criteria such as use of computerized physician order entry systems. “Under the Leapfrog program, hospitals can get positive incentives,” D’Andrea says. “If you want to compare it to what CMS is doing, you could say it’s the carrot and the stick.” However, there is growing concern from some in the medical community— led by the American Medical Assn.—that the stick CMS is swinging casts an unfair shadow. In a prepared statement, James Rohack, AMA president-elect says even their best e orts can’t prevent certain never events. “In the race to improve healthcare quality, HHS is confusing events that should never happen in a hospital, like wrong-site surgery, with often unavoidable conditions, like surgical site infections,” Rohack says. Rohack explains that to be reasonably preventable, there should be solid evidence that by following guidelines, the occurrence of an event can be reduced to “zero or near zero.” The Doctors Co., a physician-owned liability insurer based in Napa, Calif., backs the AMA’s position. There are patients, including those with diabetes or HIV, who are at risk of acquiring an infection despite the healthcare team’s best e orts at prevention, says nurse attorney Sue Dill Calloway, RN, director of hospital risk management for the Doctor’s Co. Regarding the CMS expansion of the do-not-pay list to include some orthopedic surgeries, Calloway says patients who undergo knee replacement are likely to acquire an infection, as are elderly patients prone to falling and being injured. “Our concern is that everyone is jumping on a bandwagon that isn’t going in the right direction,” Calloway says, and the concept of not paying for complications that are often a biological inevitability regardless of safe practice is “discriminatory.” CMS spokeswoman Ellen Gri th says both the original eight categories and the three categories added, were developed through a collaborative process, and subjected to notices and comment rulemaking before being adopted. The deadline, like that collaborative process, has come and gone. MHE FOR MORE INSIGHT See more Hospitals and Providers managedhealthcareexecutive.com Vision to Lead | Mission to Care The AmeriHealth Mercy Family of Companies serves more than 6.2 million members nationwide. We offer high quality services and products for health plans, states and programs that manage care for low-income populations covered by publicly funded programs. Our product lines include: t 'VMMSJTLIFBMUIQMBOT t.BOBHFNFOUBOEBENJOJTUSBUJWFTFSWJDFT t t QIBSNBDZCFOFmUNBOBHFNFOU JOUFOTJWFDBSFNBOBHFNFOU t PerformCare CFIBWJPSBMIFBMUIDBSFTFSWJDFT w w w. a m e r i h e a l t h m e rc y . c o m | f o r m o re i n f o r m a t i o n , p l e a s e c a l l 2 1 5 . 9 3 7 . 8 5 6 4 NOVEMBER 2008 25 http://www.managedhealthcareexecutive.com http://www.amerihealthmercy.com http://www.amerihealthmercy.com

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Managed Healthcare Executive - November 2008 For Your Benefit Editorial Advisors Contents News Analysis State Report Politics &�Policy Letter of the Law Affordable Access Economic Ripple Effect Hospitals &�Providers Technology Managed Care Outlook Desktop Resource Ad/Edit Index

Managed Healthcare Executive - November 2008

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