New Medicare Policy May Have Unintended Consequences in Clinical Practice

Residents who were informed about the Medicare “no pay for errors” rule were less likely to choose the most appropriate clinical practice choices in response to clinical vignettes, according to findings from a study published in the Journal of General Internal Medicine.

Somnath Mookherjee, MD, and colleagues at the University of California, San Francisco (UCSF) conducted a randomized trial of an educational intervention embedded in an online survey using clinical vignettes to estimate behavioral changes. The goal was “to determine how physicians might change their behavior after learning about the Medicare rule,” under which treatment hospitals won’t receive reimbursements for several hospital-acquired conditions unless they are documented as “present on admission.”

In the study, a group of residents were randomized to receive a one-page description of Medicare’s “no pay for errors” rule with pre-vignette reminders (intervention group) or no information (control group). Residents responded to five clinical vignettes in which conditions that fall under “no pay for errors” might be present on admission.

Of the 119 responses received, researchers found that in four of the five vignettes, the intervention group was less likely to select the most clinically appropriate response. Results showed that “most residents were aware of the rule but not its impact and specifics,” and that “residents acknowledged responsibility to know Medicare documentation rules but felt poorly trained to do so.” It was concluded residents who were educated about the Medicare’s “no pay for errors” were less likely to select the most clinically appropriate responses to clinical vignettes, and that “such choices, if implemented in practice, have the potential for causing patient harm through unnecessary tests, procedures, and other interventions.”