The Centre for Medicare and Medicaid Services (CMS), an agency within the US Department of Health and Human Services is responsible for the administration of various key federal health care programs with a main mission of enhancing the timely delivery of quality health care to Medicare and Medicaid beneficiaries and ensure that these programs are administered in an efficient manner. The agency also ensures that program beneficiaries are aware of the services they are entitled to receive, and that those services are accessible and of high quality. To achieve its mandate, the agency has adapted policies, actions and legislation that help to ensure that beneficiaries receive quality health care services at a reasonable cost.
According to Health care business, as part of the agency’s policy and obligation to better the quality of care that patients get during a hospital visit and to make sure they only pay for the items and services that are reasonable and necessary (Tarkasi, 2009). The agency adopted some measures aimed at making hospitals safer. Hospitals are now required to minimize the likelihood of certain events that could occur during hospital stay, and to reduce hospital acquired conditions. The agency encourages accountability from providers for complications that occur after a patient is admitted to the hospital linking re-imbursement to quality and performance. This re-imbursement policy requires hospitals to identify advance events during the inpatient stay that could theoretically be prevented by hospital interventions (Centers for Medicare & Medicaid Services, 2013). The agency came up with a list of the “never events”, conditions that should be considered entirely preventable, and hospitals are not allowed to charge patients directly for care related to these events.
In as much as this rule will favors the CMS and other insurers, by way of making savings, hospital operators believe that this rule will profoundly impact on not only their financial well-being of the hospitals, but it could also affect the quality of care in a negative manner. Therefore, there was a dire need for the concerned players to engage and get a middle ground which could have resulted in shifting the patient care delivery model for mutual benefit.
Home - Centers for Medicare & Medicaid Services. (2013). Retrieved from http://www.cms.gov/
Tarkasi, C. (2009). Never-events’ Policy may save less than expected. Health Care Business New.