The CMS added three additional hospital-acquired conditions for which Medicare will no longer reimburse beginning Oct. 1, bringing that total to 11. The agency also will require hospitals to report on 13 more quality measures under the inpatient prospective payment system 2009 final rule announced this afternoon.
In addition, the CMS announced final 2009 rules for the inpatient rehabilitation facilities and skilled-nursing facility prospective payment systems. Medicare expects payments to IRFs will be $5.6 billion in fiscal 2009, using a calculation of case-mix groups that weighs the types of patients being treated and resources required by the rehab facilities. Payments to nursing homes will go up by $780 million, a result of a 3.4% increase in the annual market basket calculation of cost of goods and services for a skilled-nursing facility stay, according to the CMS.
Originally hospitals were to stop receiving payment for eight conditions, a mix of hospital-acquired infections and National Quality Forum-endorsed never events, but the final rule brought that number up to 11. Medicare expects to save about $20 million a year from the new reimbursement policy, according to acting CMS Administrator Kerry Weems. The agency has been working with hospitals over the past year to prepare their coding procedures for the policy changes coming in October. Weems added that CMS is encouraging state Medicaid programs to adopt similar reimbursement policies.
The three additional conditions are: surgical-site infections following certain orthopedic and bariatric surgeries; certain manifestations of poor control of blood sugar levels; and deep-vein thrombosis or pulmonary embolism following total knee and hip replacements. The original eight conditions are: foreign object retained after surgery; air embolism; blood incompatibility; Stage III and IV pressure ulcers; falls and trauma; catheter-associated urinary tract infection; vascular catheter-associated infection; and surgical site infection-mediastinitis after coronary artery bypass graft. -- by Jean DerGurahian
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