Abstract
The proposed Medicare reimbursement schedule intended to become effective in October 2008 represents a drastic change to the traditional policy of payment for needed services. The proposal mandates that certain preventable adverse events should not be reimbursed. This spending scheme is intended to improve quality while decreasing cost to the Medicare system. The goals of the spending scheme are laudable. Quality improvement, when used to improve the health, safety and general welfare of the intended patient beneficiary of the Medicare program, is a rational and compelling government interest that warrants coercive use of authorized spending power. This beneficial interest may also rationally justify regulation of the health care industry through conditional acceptance agreements. However, the spending power and imposed regulations must bear a rational relationship to the intended goals and purpose of Medicare. Unintended consequences that will likely result from a refusal to pay for necessary medical care because of hindsight review will likely decrease the quality and increase the cost of the Medicare program. Therefore, rather than impose the proposed spending scheme of non-payment for serious adverse events Congress, through CMS, should utilize its vast resources to encourage valid compilation of quality data throughout America's hospital and health care system. It should provide a means to obtain a non-biased and objective analysis of the data and identify methods which improve quality while balancing cost efficiency and avoiding undue punishment. Publication should not occur until valid and open discussion has brought concurrence about realistic goals and methods of accomplishment
Recommended Citation
Note, To Pay or Not to Pay: Medicare and the Preventable Adverse Event: A Rational Decision of Dangerous Philosophical Change, 22 J.L. & Health 91 (2009)