The draft of the fiscal 2010 inpatient prospective payment system does not include additions to the list of hospital-acquired conditions for which Medicare will not pay, a move that hospital officials praised as wise.
CMS hanging tight at 11
CMS IPPS draft for ’10 keeps never event list as is
The CMS wrote in the proposed rule that instead of adding more conditions this year, it would take time to review its no-pay policy and determine what impact it has had on hospitals. The review will be conducted jointly with the Centers for Disease Control and Prevention and the Agency for Healthcare Research and Quality. That evaluation process will provide valuable information for future policymaking aimed at preventing HACs, the federal agency wrote in the proposed payment system. The agency estimated it will save $22 million a year over the next five years through its HAC policy.
The CMS will analyze present-on-admission, or POA, data in its evaluation of the no-pay program. Hospitals have been providing information on whether a condition was present when the patient was admitted to the agency since 2007.
In October 2008, the CMS began to apply POA information in its reimbursement decisions, and refused to pay for care that bumped patients into a higher DRG if it was revealed that the hospital was responsible for the increased care being needed. The CMS currently does not pay for 11 conditions it considers to be preventable (Sept. 15, 2008, p. 36).
Its time for the CMS to do the analysis, said Mary Nickel, director of medical staff support, clinical quality and risk management for 37-bed St. Clares Hospital, Weston, Wis., part of the Milwaukee-based Ministry Health Care network. That piece has not been done yet.
The first year hospitals collected POA information was a year of ongoing education, Nickel said. Doctors especially had to be made aware of how they were coding information in patient charts, and the hospital spent time teaching patients about techniques they could practice to reduce their chances of acquiring an infection after they came to the hospital, she said.
With all the information the CMS has collected, its time to consider how the different HACs on the list are acquired by different patients, Nickel said. For example, while its clear that a foreign object should never be retained in any patient after any procedure, conditions like deep-vein thrombosis or embolisms have more gray area. Some patients are at greater risk for those conditions, Nickel said. I think the CMS should step back and ask, How do we risk adjust?
Taking that step back to review the program is important, said Nancy Foster, vice president of quality and patient safety at the American Hospital Association. Ensuring coding accuracy with POA information, she said, takes an extraordinary amount of effort. It may not be yielding the benefit to patient care in the way that CMS had hoped, she said.
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