For example, Hospital A would not receive payment for expanded care required for a patient who developed a preventable stage IV pressure ulcer. But if that patient were transferred to Hospital B, Medicaid funds would pay.
But, Feldpush says, that's won't happen in any systematic way.
"That would take a degree of sophistication and almost trickery that I don't believe occurs," she said. Hospitals want to do right by their patients the first time around. We worked on this issue for many years. They want to make it right," she said.
With state coffers so distressed, it might seem prudent for the agency to provide more uniformity across state lines. That might incentivize hospitals to work harder in these categories where they are tightly compared with their peers.
It seems wrong that hospitals in some states might be held to a much lower standard in how they are penalized for causing harm. By pushing out such a vaguely worded rule, CMS may have placed a piece of the jigsaw puzzle that will take a long time to correctly fit.