Physicians Beware: CMS Ups the Financial Ante on Wrong-site Surgery

By Ruth Elzer, RN, MS

There was much publicity when the Centers for Medicare and Medicaid (CMS) placed wrong-site surgery on the list of “Never Events” for which Medicare would not pay hospitals. In publishing the “Never Events” list, CMS said that the federal government would no longer pay hospitals when the wrong surgical procedure was performed. Few people, including hospitals, argued with the idea that hospitals should not be paid for doing the wrong surgical procedure. By denying payment to hospitals, CMS decided that hospital leadership needed to ensure that proper procedures were followed to prevent these wrong surgeries.

What the public may be surprised to know is that as recently as the first half of 2008 (prior to implementation of the “Never List”), twenty percent of Joint Commission surveyed hospitals were cited for failing to have a proper “time out’, part of the Universal Protocol, the process designed to prevent wrong-site surgery.  To properly implement this patient safeguard, all members of the surgical team (surgeons, nurses, anesthesiologists) must stop what they are doing and participate in the “time out”.

Recently, CMS clarified its intentions for non-payment for services related to wrong-site surgery. Additional information released in Transmittal 1755 on June 12, 2009 stated that surgeons and other practitioners, including anesthesiologists, will not be paid for professional services associated with wrong-site surgery because “Medicare will also not cover hospitalization and other services related to these non-covered procedures.“  These include:

·                     All services provided in the operating room when an error occurs are considered related and therefore not covered.

·                     All providers in the operating room when the error occurs, who could bill individually for their services, are not eligible for payment.

·                     All related services provided during the same hospitalization in which the error occurred are not covered.

While hospitals have realized the potential impact of wrong-site surgery on their payment, physicians such as anesthesiologists and radiologists, may not be aware that payment for their services will also be denied.  It may be logical to deny payment to anesthesiologists who should be part of the “time out” procedures, but it is harder to build a logic that justifies denying payment to physicians who were not involved in the surgical mishap and are subsequently brought in to “rescue” the patient. Isn’t this punishing the innocent as well as the guilty?

Nevertheless, the intent of this announcement is a good thing: to provide additional incentives to gain compliance with patient safety procedures to prevent wrong-site surgery. Non-committed participation by all members of the surgical team is unacceptable. Attempts to influence behavior by reasoning and trumpeting the cause of patient safety have not seemed to be enough to adopt new behaviors. It will be interesting to see whether the addition of this financial incentive improves the adoption of this patient safety procedure. If it isn’t enough, the next steps are likely to be more draconian. 

To read the Full Transmittal.