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Some experts disagree with the Medicaid malpractice payment rule

Next summer Medicaid is set to stop paying for treatment that is necessary due to medical malpractice mistakes. The director of the Centers for Medicare & Medicaid Services said that the nonpayment of malpractice injuries by Medicare will encourage better patient outcomes.

Some physicians in Boston and around the country are skeptical that stopping Medicaid payments will have the desired effect of improving patient safety. The CEO of the American Medical Association said that the Medicaid policy is unwise.

"Simply not paying for complications or conditions, that, while extremely regrettable, are not entirely preventable, is a blunt approach that is not effective or wise for patients or the Medicare or Medicaid program," he said.

The CEO said that the medical association also took issue with the Medicaid rule's provision that allows states to expand the list of medical malpractice "never events" that will not receive Medicaid coverage.

The list of preventable conditions no longer covered by Medicaid under the new rule includes spine, neck, shoulder and elbow injures as well as certain types of comas, among other things. Burns, falls and trauma, dislocations, and wrong site surgery are also no longer covered as of July 2011.

The executive director of the National Association of Medicaid Directors said that the rule is a first step in a national discussion of medical quality. The director also stressed that the effort to improve quality in both the Medicaid and Medicare programs is an important, but added that such improvements should be done in a coordinated fashion.

Source: Kaiser Health News, "Medicaid To Stop Paying For Hospital Mistakes," Phil Galewitz, 6/1/11

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