NBCA Medicare/Medicaid Victory - Reimbursement Denial For Mismanaging Blood Clots! 

CMS Announcement Will Lead to Many Saved Lives

On July 31, 2008, The Centers for Medicare and Medicaid Services (CMS), the federal agency that finances Medicare and Medicaid, in keeping with NBCA’s position, announced dramatic steps to curtail medical errors that lead to blood clots in patients following total knee and hip replacement procedures. Because appropriate prophylaxis is highly effective in preventing a deep vein thrombosis (DVT) or pulmonary embolism (PE) in knee and hip replacement patients, CMS will no longer reimburse hospitals for costs associated with this care, even if the blood clots occur for a period of time after hospital discharge. The fiscal reality of reimbursement denial will provide an incentive for hospitals and surgeons to make sure that best practices are followed in preventing clotting, which will now be considered a medical error when these regulations go into effect on October 1, 2008. Randy Fenninger stated that "this is a landmark decision that will lead to many lives saved in the years ahead."

NBCA executive director Alan Brownstein said "I am proud that NBCA with guidance from the leadership from our Medical and Scientific Advisory Board, presented a forceful, but balanced position paper tying quality of care to reimbursement." Brownstein added, "indeed NBCA assumed an important 'stop the clot' position, and so did CMS."

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