U07d2 Reimbursement Reform - Essay Example

Running Head: u07d2 REIMBURSEMENT REFORM u07d2 Reimbursement Reform Submitted by: Setara Azizi Number: XXXXXXXXX Capella Name:The extremely serious events and the adverse events in the health care industry which could have been prevented are referred to as the ‘Never Events’. This report aims at discussing the specifics of the October 2008 Final Rule implementation about the ‘never events’ and the cases of non payments. The main underlying reasons for the ‘never events’ has basically been the human errors.

The term ‘never events’ was coined by the Medicare and Medicaid listed out a number of events that could have been reasonably prevented. This list was developed with based on number of consultations with the stakeholders and the National Quality Forum. The National Quality Forum is a nonprofit organization that brings to sight the measurement issues from the health care spectrum (Mattie, 2008). The Centre for Medicaid and Medicare arrived a conclusion that there would not be any reimbursements for the events and this led to a number of debates in the industry.

The main intension of this decision was to help improve the safety of the patients and also to improve the overall quality of the healthcare systems. The intension was that if no reimbursements were to be provided to the hospitals for these errors then there would be more care and attention that is given and thereby better practices in the healthcare. The hospitals were getting paid excessively and the doctors were been seen to become more and more irresponsible and careless. Take for instance, if the doctors made an error and the patient required to go through another treatment for the rectification of the error, the doctor would be paid for both.

In order to meet up to the current events in the health care and to ensure that doctors were accountable for their actions, the CMS brought in the initiative and the pay would not be given to the doctors in case of errors (DerGurahian, 2010). The initiative was followed by the insurers as well and newer and more versions were developed to ensure that the ‘never events’ were not paid for. This initiative has led the hospitals and the health care organizations to work harder to ensure bettered and more responsible behavior from the doctors and all people within the hospitals.

There have been several insurers which have also agreed to withhold the payments even if a single error was to be conducted during the procedures. The basic reason why this initiative was taken is one which is very helpful, as if any error or event was to happen and was not supposed to happen, and then it was incorrect for the healthcare to be paid for the same. This was a very positive manner of managing the health care industry. IT simple meant, ‘we pay you not for what you do, but for what you do right!

’ (Bunting, Schukman, & Wong, 2009).The rules were set down by the Center for Medicare and Medicaid and this has been followed by all even the private insurers, thereby making the doctors and health care industry more alert and responsible and also accountable for their actions. ReferencesBunting, R. F., Schukman, J., & Wong, W. B. (2009). A Comprehensive Guide to Managing Never Events and Hospital-Acquired Conditions. Atlantic Information Services.DerGurahian, J. (2010). ‘Never-events policy may save less than expected.

Retrieved February 28, 2010, from http://www.modernhealthcare.com/section/neverevents#Mattie, S. J. (2008). Centers for Medicare and Medicaid Services "Never Events": An Analysis and Recommendations to Hospitals. The Health Care Manager: , 27 (4), 338-349.