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Press Start: Lead an Empowered Life as a Clinical Laboratorian

Medicare New Reimbursement Rules and Laboratory Errors

Published March 20, 2008 10:06 AM by Glen McDaniel
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.

3 comments

Paul Levy, president and CEO of Beth Israel Deaconess Medical Center, Boston, in his recent blog "Running

February 13, 2009 8:48 AM

New York Medicaid program has announced it will not pay for what it terms 14 " never events ." I recently

July 14, 2008 10:19 AM

What about a patient that has been diagnosed and then treated based on lab results that may have had an undetectable pre-analytical error associated with them?

Any tech can spot a 2.1 hemoglobin and a 1300 Glucose as being suspicious, but what about a mislabeled ER sample, an incorrectly dated and timed sample tube, an aliquot from an improper sample vessel or something as simple as a registration spelling error?  Many pre-analytical errors aren't exactly "in your face" and may not present until later on.

These can have consequesnces from a sick patient not being treated to one receiving an incorrect/incompatible blood product  type.  Hopefully, these results pass through enough hands and there are some fail-safes that have been put in place to catch these errors, that many are caught before the fish gets fried.  

There is no worse feeling than having to call to question a result or call to amend a report because it was found out after the fact that someone who drew the blood mislabeled it and the results  reported out were completely off base and there is someone out there with actual critical results

Ryan , MT June 6, 2008 5:36 PM
Buffalo NY

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