Vancouver Business Journal

Sat04192014

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Trust, Park Service fail to reach agreement on Pearson Air Museum

Trust, Park Service fail to reach agreement on Pearson Air Museum

Several months after having entered into formal mediation talks to discuss issue...

Riverview Community Bank celebrates regulatory decision

Riverview Community Bank celebrates regulatory decision

Officials at Riverview Community Bank are moving forward with confidence knowing...

Commercial development: Building for tomorrow

Commercial development: Building for tomorrow

If commercial developers feel like circus performers walking a tightrope, there ...

 Business Growth Award finalists announced

Business Growth Award finalists announced

14 businesses have been named finalists for the Vancouver Business Journal's 201...

Is Food Processing part of Port “Comprehensive Scheme”?

Is Food Processing part of Port “Comprehensive Scheme”?

The leaders of a Clark County food processing company will bring their efforts t...

Developers cautious but developing

Developers cautious but developing

Although the Great Recession is behind us, many businesses and individuals are s...

Design & Construction

Commercial development: Building for tomorrow

Commercial development: Building for tomorrow

If commercial developers feel like circus performers walking a tightrope, there is good reason.

Limited financing, escalating regulatory and raw material costs, and still-low property valuations make penciling out a project difficult. And yet, workforce trends and emerging technologies demand designs that look to the future.

Build to the budget

According to Ron Frederiksen, president of RSV Bui...

Innovation & Manufacturing

Southwest Washington keeps its focus on manufacturing

Southwest Washington keeps its focus on manufacturing

Southwest Washington boasts a number of regional factors that are beneficial to the local economy. Among them are access to clean water, affordable power and a skilled workforce. These factors have continued to drive the local manufacturing industry in 2014 – an industry that was one of the first to convincingly move forward out of the recession.

“Advanced manufacturing aligns with both our Orego...

News Briefs

CREDC seeks health care startups to participate in “Shark Tank”

The Columbia River Economic Development Council (CREDC) is accepting applications from startups related to the health care sector interested in participating in Clark County PubTalk’s annual business pitch competition on Tuesday, June 17.

Spotlight

Audio Fox: A sound solution

Audio Fox: A sound solution

Like a lot of small businesses, Vancouver-based Sound Product Solutions started with a problem. Several years into retirement, Rex Clark was experiencing hearing loss – and he wasn’t the only one affected by that change.

“We had some disagreements, me and my wife, about where the volume should be on the TV,” said Rex. He remembered similar struggles between his own parents, but the best solution ...

Hospitals to lose ‘never event’ reimbursement

Starting Oct. 1, hospitals throughout the country will stop receiving Medicare reimbursement for so-called “never events,” such as pressure sores and falls. And many private insurers such as Aetne Inc. and WellPoint Inc. are incorporating similar restrictions in their contracts with hospitals.

Starting Oct. 1, hospitals throughout the country will stop receiving Medicare reimbursement for so-called “never events,” such as pressure sores and falls. And many private insurers such as Aetne Inc. and WellPoint Inc. are incorporating similar restrictions in their contracts with hospitals.

Hospitals receive Medicare reimbursement under the Medicare Inpatient Prospective Payment System, and the amount of reimbursement is based on the diagnosis-related group that describes a patient’s treatment. Under the upcoming change, hospitals will not receive additional reimbursement for certain secondary illnesses caused by the hospital, or that occurred while a patient is in the hospital.

For example, if a patient is admitted for knee replacement surgery, the hospital is paid a set amount for that treatment. However, if the patient develops a pressure sore at the hospital following knee replacement surgery, the hospital will not be paid for treatment of the pressure sore.

The concept of never events was developed by the National Quality Forum and the Leapfrog Group. The National Qualify Forum, a nonprofit group that was created to develop a national strategy for healthcare quality measurement, has a list of 28 never events. And the Leapfrog Group, a national coalition of major employers and health plans, gives recognition to hospitals that take responsibility for never events, including waiving the costs associated with the event, apologizing and reporting the event.

The Centers for Medicare and Medicaid Services, the agency that administers the Medicare and the Medicaid programs, has identified eight never events. They include objects left in patients during surgery, air embolism, blood incompatibility, catheter-associated urinary tract infection, vascular catheter-associated infection, pressure sores, certain surgical site infections and hospital-acquired injuries such as fractures, dislocations, intracranial injuries, burns and crushing injuries.

One of the goals of restricting never-event reimbursement is to improve patient care, but the mandate given to CMS was to identify conditions that had a high cost or occurred frequently so as to lower Medicare payments.

Many of the conditions described above, like leaving an object in a patient during surgery, would clearly be the result of negligence. However, some never events, like the development of pressure sores, can be clinically unavoidable based on a patient’s condition. Other never events, like falls, can occur regardless of the amount of care planning and supervision of the patient.

Because the determination as to payment will be based on whether the secondary illness developed in the hospital, hospitals will be required to do a more thorough job of screening patients when they are admitted. They also will be required to report the occurrence of the never events themselves.

In testimony to the House Committee on Ways and Means on Feb. 14, 2008, acting CMS Administrator Kerry Weems, proposed that hospitals failing to report never events be subject to a 2 percent annual reduction in their reimbursement levels. And major insurers have begun to include never event provisions in their new contracts with hospitals. The new contract language requires reporting the occurrence of the never event, and prevents payment to the hospital by the insurance company and the hospital from billing the patient directly.

The effects of these rule changes may be seen throughout the hospital industry.

Care will likely improve – money is a serious cudgel – but hospitals will act more defensively with respect to never events, which will probably increase costs due to more paperwork and tests. And plaintiffs who have suffered an injury will likely argue that because the injury is classified as a never event, the hospital is liable, regardless of whether the injury was unavoidable – which will probably increase malpractice insurance costs.

One can expect this trend to continue, and for CMS and insurers to expand the list of never events and to apply similar payment restrictions to other providers, such as skilled nursing homes and physicians.

 

Aaron Besen is an of-counsel attorney at the Vancouver office of Bullivant Houser Bailey PC, where he represents long-term care providers, landlords to these providers and related businesses. He can be reached at 360-737-2300 or This email address is being protected from spambots. You need JavaScript enabled to view it. .

Opinion

Focus Column

Innovating innovation

Innovating innovation

If you want to attract innovation, you need to be innovative. The Clark County Economic Development plan, which guides t...

You can thrive without reinventing the wheel

You can thrive without reinventing the wheel

Every day the media bombards us with headlines of doomsday for American manufacturers. We read how competition is stiff,...

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