Medicare New Reimbursement Rules and Laboratory Errors
Under new Medicare regulations
effective October 2007, hospitals will no longer receive higher payments for the additional costs associated with treating patients for certain hospital- acquired infections and medical errors.
Previously, complications could be used to increase the weighting of a diagnosis related group (DRG) over and above the diagnosis given to the patient on admission. For example, if a patient is admitted on a ventilator, with a central line and develops hospital-acquired MRSA, Medicare will no longer pay for treating the MRSA.
Initially eight commonly-encountered conditions have been targeted by CMS. These include blood/crossmatch incompatibility, pressure ulcers, injuries from falls and infections such as blood stream infections secondary to wounds or catheter contamination. If not present on admission, these complicating conditions will not be reimbursed.
This is all designed to improve patient safety-and to reduce Medicare spending. It is very likely that this list "unreimbursed conditions" will be expanded as time goes on. Because so much of medical care is dictated by the results of laboratory testing, the laboratory staff will play an increasingly important role. Laboratory data will be useful in documenting, for example, that a condition was present on admission (POA) and therefore reimbursable-or the converse: no lab results on chart, not reimbursable.
Under this regulation it is very possible going forward, laboratory data can be considered in other ways as well. What about a wrong diagnosis resulting from an incorrect test, delayed results or incorrect results. Might the lab be inducted into controlling preanalytical and postanalytical phases of testing more than is currently done?
Bottom line: the lab will continue to play a pivotal role in ensuring safe patient care.