In an effort to "strengthen the tiebetween the quality of care provided to Medicare beneficiaries and payment for the services provided when they are in the hospital," the Centers for Medicare and Medicaid Services (CMS) increased its list of preventable conditions that Medicare will no longer pay at a higher rate if they occur during a patient'shospital stay. These measures arebeing taken to ensure that benefi ciariesreceive safe and efficient care from healthcare providers, as well as provide greater value for both Medicare beneficiaries and the program itself.
List of Conditions
The CMS' list of conditions, which went into effect October 1, identifyselect hospital-acquired conditions that are high cost, high volume, or both;result in the assignment of a case to a Diagnosis-Related Group that has a higher payment when present as asecondary diagnosis; and could reasonably have been prevented through the application of evidence-based guidelines. The eight selected con ditions include:
1. foreign object retained after surgery
2. air embolism
3. blood incompatibility
4. stage III and IV pressure ulcers
5. falls and trauma
* fractures
* dislocations
* intracranial injuries
* crushing injuries
* burns
6. catheter-associated urinary tractinfection
7. vascular catheter-associatedinfection
8. surgical site infection-mediastinitis after coronary artery bypass graft.
Reported Conditions
In addition to these specific conditions, CMS has expanded its list of conditions to be reported upon the patient's first admission. These con ditions encompass a variety of different infectious conditions and areas, and include the following:
* surgical site infections followingcertain elective procedures
* Legionnaires' disease
* glycemic control
* Iatrogenic pneumothorax
* delirium
* ventilator-associated pneumonia
* deep vein thrombosis/pulmonary embolism
* Staphylococcus aureus septicemia
* Clostridium difficile associateddisease.
Second Initiative
CMS has also established a secondini tiative revolving around the expansion of its hospital quality measurereport ing program. Whereas hospitals were required to report just 30 quality measures on their claims to qualify for a full update to theirfiscal year 2009 payment rates, CMS has added 43 additional quality measures. These additions include the following:
* Surgical Care Improvement Project: 1 new measure
* hospital readmissions: 3
* nursing care: 4
* patient safety indicators developed by the Agency for Healthcare Research and Quality (AHRQ): 5
* inpatient quality indicators developed by the AHRQ: 4
* venous thromboembolismmeasures: 6
* stroke measures: 5
* cardiac surgery measures: 15.
Effects of Application
CMS officials note that the proposed rule applies to more than 3,500 acute care hospitals paid under the Inpatient Prospective Payment System, and is estimated to increase Medicare payments to acute care hospitals by nearly $4 billion. The rule also includes proposals to update Medicare payment rates and policies for inpatient hospitals for fiscal year 2009.
For more information, visit the CMS' Hospital-Acquired Conditions Web page at http://www.cms.hhs.gov/HospitalAcqCond/.