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Missouri: Focus on Nonpayment for Adverse Events

Nonpayment for adverse events is the focus of Missouri's payment reform. Its Medicaid program, MO Healthnet, instituted a nonpayment policy for preventable serious adverse events and hospital or ambulatory surgical center–acquired conditions on June 30, 2009. The policy covers the Centers for Medicare and Medicaid Services (CMS) list of hospital-acquired conditions as well as 26 of the 28 events on the National Quality Forum's (NQF) list of serious reportable events (both as of December 15, 2008). More detailed summaries of the regulation are available from the Missouri Hospital Association.

Missouri took this targeted approach to patient safety in part because incremental change was seen by state leaders as more feasible than broader health system reforms. Becky Miller, executive director of the Missouri Center for Patient Safety, describes the policy as the basis for an evolving patient safety strategy in the state. "Medicaid's involvement can serve as a springboard for future work on prevention of adverse events," she says. Such work will be informed by the data collected on the impact of the new policy.

The nonpayment policy originated with MO Healthnet as an effort to align the Medicaid agency's policy with Medicare's recent shift to nonpayment for hospital-acquired conditions. The Missouri Hospital Association collaborated with the Medicaid agency to expand the regulation to include nonpayment for NQF events, as well as the CMS events. Miller noted that, while hospitals were already familiar with the Medicare nonpayment policy, ambulatory surgery centers have had to adjust to the regulation. The new policy requires the facilities to contract with a federally designated patient safety organization, such as the Missouri Center for Patient Safety, to report and analyze adverse events and identify strategies and opportunities to prevent them.

"There was interest across the state in transparency, and a history of previous bills on this issue that did not pass, so this regulation benefited from longstanding motivation among providers, legislators, and others to learn more about medical errors," Miller said. "Whenever you're talking about patient safety, you really should have everyone on the same wavelength, and the relationships between the Medicaid program, hospitals, and physicians were critical to enacting this policy, as they are to implementing it successfully."

For more information

See or contact Becky Miller, executive director, Missouri Center for Patient Safety, at [email protected]

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