Hospitals and physicians are criticizing the CMS for increasing the number of conditions for which Medicare will no longer reimburse when its policy for not paying for certain conditions goes into effect.
Its questionable whether the conditions are preventable and how they are to be recorded as present-on-admission is unclear, said Beth Feldpush, senior associate director for policy at the American Hospital Association. We did not agree with any of the conditions when they were proposed earlier this year, she said.
The original reimbursement policy included eight conditions. 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 after coronary artery bypass graft.
But many of those conditions in the policy are not backed up by solid evidence as being completely preventable, according to J. James Rohack, a physician who is president-elect of the American Medical Association. Focusing on determining whether or not medical conditions exist when the patient enters the hospital will increase Medicare spending on tests and screenings with questionable benefit to patients, Rohack said in a written statement.
The final acute-care inpatient payment system 2009 rule included both the three hospital-acquired conditions and 13 more quality measures hospitals will be required to report on through the federal Hospital Compare Web site>
Being so focused on measurement reporting has made the CMS lose sight of the goal of improvement, said Edward Gamache, administrator and chief executive officer of Deckerville (Mich.) Community Hospital. More effort needs to be made in targeting the measurements that hospitals are still failing on before the CMS should require additional reporting, he said. Theyre not focusing on the real intent. -- by Jean DerGurahian
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