Patients have the right to receive quality healthcare service. When healthcare recipients, particularly persons 65 or older, younger people with disabilities and end-stage renal diseases, with Medicare coverage receive medical care, the healthcare centers they access are reimbursed for the care that they provide at a fixed pre-agreed rate by the CMS. The reimbursement system may be in the form of an inpatient prospective payment system, or the outpatient prospective payment system ( Mattie & Webster, 2008 ). The patient is responsible for paying other copayments, including coinsurance, and any other deductibles that they may owe, but the healthcare provider cannot bill the patient if their normal rates are different from those provided by Medicare. I think this is a good system to protect patients from overcharge, and allow them to review the quality of care that they receive.
Reimbursement covers inpatients and outpatients in the specific conditions defined by the CMS. However, I think that the CMS should review the ‘Never Events’ to cover a wider range of nosocomial infections, and also support the patients to take legal action if they are forced by healthcare providers to pay for these treatments ( Mattie & Webster, 2008 ). The Deficit Reduction Act of 2005, under section 5001(c) noted that hospitals could not be reimbursed for treating nosocomial infection, also known as healthcare-associated infections (HAI). Among these infections are UTIs, meningitis, and pneumonia. These infections can be reduced and controlled by the hospital’s vigilance, maintenance of high levels of hygiene, and other anti-biotic control policies (Khan et al, 2017). CMS protects itself from reimbursing these cases, and I think it should inform the patient of their rights such that they know when to take legal action, and the extent to which they are protected by the law regarding HAIs. CMS is in a better position to take these actions since they understand the causes of HAIs, while many patients do not.
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References
Khan, H. A., Baig, F. K., & Mehboob, R. (2017). Nosocomial infections: Epidemiology, prevention, control and surveillance. Asian Pacific Journal of Tropical Biomedicine , 7 (5), 478-482.
Mattie, A. S., & Webster, B. L. (2008). Centers for Medicare and Medicaid Services'" Never Events": An Analysis and Recommendations to Hospitals. The health care manager , 27 (4), 338-349.
