The Centers for Medicare & Medicaid Services (CMS) in April proposed to expand the list of hospital-acquired conditions for which they won’t pay, in an effort to improve quality of care, cut the rate of hospital-acquired infections, and, in the process, control healthcare spending. The new list of conditions would be in addition to those for which the feds have already decided to stop paying effective Oct. 1, 2008. For providers, the new proposal only increases the pressure to get things right first time, all the time.
The first eight conditions, which were selected last year, are:
- Object inadvertently left in after surgery
- Air embolism
- Blood incompatibility
- Catheter-associated urinary tract infection
- Pressure ulcer (decubitus ulcer)
- Vascular-catheter-associated infection
- Mediastinitis (infection in the chest) after coronary artery bypass graft surgery
- Certain types of falls and trauma.
The proposed list includes the following conditions, if acquired during the hospital stay:
- Surgical site infections following certain elective procedures
- Legionnaires’ disease (a type of pneumonia caused by a specific bacterium)
- Extreme blood sugar derangement
- Iatrogenic pneumothorax (collapse of the lung)
- Delirium
- Ventilator-associated pneumonia
- Deep vein thrombosis/pulmonary embolism (formation/movement of a blood clot)
- Staphylococcus aureus septicemia (bloodstream infection)
- Clostridium difficile-associated disease (a bacterium that causes severe diarrhea and more serious intestinal conditions, such as colitis).
In addition, CMS is proposing to expand the hospital quality measure reporting program, which reduces the amount a hospital is paid if it does not participate in the voluntary reporting of standardized quality measures. Hospitals are currently required to report 30 quality measures on their claims for Medicare inpatient services to qualify for a full update to their FY 2009 payment rates. CMS is proposing to add 43 quality measures to the list, including:
- Surgical Care Improvement Project (one new measure).
- Hospital readmissions (three new measures).
- Nursing care (four new measures).
- Patient safety indicators developed by the Agency for Healthcare Research and Quality (five new measures).
- Venous thromboembolism measures (six new measures).
- Stroke measures (five new measures).
- Cardiac surgery measures (15 new measures).
In proposing to require hospitals to report on readmissions, CMS notes that almost 18 percent of Medicare patients are readmitted to the hospital within 30 days of discharge. Not only do readmissions expose the patient and their family to additional suffering, but readmissions cost the government $15 billion annually, with $12 billion of those costs potentially preventable, according to CMS.
There will no doubt be some wrangling over which of these conditions and measures are finally incorporated in the regulation, but there’s one thing about which JHC readers should have little doubt: The government is going to continue to keep the heat on providers to improve the quality of patient care. The question for JHC readers is this: Do the products that you are bringing into your facilities support that? Ask your vendors for help in answering that question.
