Hospital Complications: Linking Payment Reduction to Preventability

摘要

The Centers for Medicare & Medicaid Services (CMS) accelerated its adoption of pay-for-performance incentives in October 2008 when it began denying the extra Medicare payments generated by certain in-hospital complications, known as hospital-acquired conditions (HACs). The stated purpose of the payment denial is to simultaneously reduce Medicare payments and provide hospitals with financial incentives to improve quality. However, the policy of eliminating the entire payment increase because of an HAC has led some to characterize HACs as a "killer back-end denial tool" that represents "pay-for-perfection" rather than pay-for-performance. Others have warned that HACs will "inevitably be incorrect sometimes, leading it [CMS] to deny payment for complications that are not preventable." Even those who have characterized HACs as a "bold experiment" have raised concerns about unintended consequences. Although these concerns are reasons for caution, they relate more to the precise method of implementation rather than the underlying pay-for-performance principle.