The wisdom and justice of not paying for "preventable complications."
In October 2008, Medicare will put into effect a new policy that withholds payment for eight preventable complications of care, with plans already in place to expand this list in 2009. This initiative has prompted several discussions in the safety community, ranging from the business case for adopting such a policy to whether any of the targeted conditions can be accurately identified as present on admission. This commentary further explores the basis of Medicare's efforts and focuses on criteria that should be considered when withholding payment for complications of care. The authors provide a framework that requires each proposed complication to be important, measurable, and truly preventable to meet the burden of proof for inclusion. Only foreign objects retained after surgery and catheter-related blood stream infections serve as "wise and just" complications based on their assessment. While the authors acknowledge the opportunity for Medicare to align payment incentives and stimulate improvements in quality and reduce costs, they caution against rapid adoption and a failure to carefully evaluate the benefits and risks of the initiative.