Medicare’s ‘No-pay’ Rule Has Lead to Improvements in Infection-Control in Health Care Facilities

When it was first adopted, Medicare’s ‘no-pay’ rule was a controversial topic in the world of healthcare. Under the ‘no-pay’ rule, healthcare facilities are not eligible to receive Medicare funding for treatment of conditions acquired within the facility. However, this rule has actually proven to be beneficial to improving quality standards of healthcare facilities, as hospitals and nursing homes now have a greater incentive to prevent infections and other conditions from developing under their watch.

While many different conditions are can be facility-acquired, the three most common were various types of infections related to surgical procedures and the use of catheters. Some other examples of common infections include Methicillin-resistant Staphylococcus aureus (MRSA), scabies, Clostridium difficile (C. difficile), and sepsis. In a recent study by the American Journal of Infection Control, reported by American Medical News, it was found that 70% of professionals now claim that they are spending more time educating their staff on infection prevention techniques as a result of the ‘no-pay’ rule.

This is not the first incentive program that Medicare has implemented, however.
For example, another recently enacted Medicare program makes the amount of funding provided to a healthcare provider directly contingent upon its quality rating. Meanwhile, the Department of Health and Human Services will award healthcare agencies up to $216 million in funding for reducing preventable injuries.

While they have proven to be beneficial, the necessity of incentive programs highlights the many conditions that can develop as a result of nursing home neglect and understaffing. Some nursing homes will even “downcode” serious conditions in order to relieve themselves of liability and continue to receive funding from government healthcare agencies. This dangerous practice further decreases your loved one’s chances of receiving the care that he or she requires. Because nursing homes and other healthcare facilities have incentives to hide conditions from government health agencies, it is important for you to be extremely attentive of your loved one’s health. Rather than blindly accepting the nursing home’s assessment of your loved one’s health condition, you should often examine your loved one yourself. It is important for you to be aware of all these abuses before choosing a nursing home for your loved one.


Proudly serving the greater Los Angeles area, including Cerritos, Claremont, and Commerce, the Law Offices of Ben Yeroushalmi promises to fight relentlessly for your loved one’s rights . If you feel that your loved one is a victim of nursing home neglect, please contact us today to see how we can help.