Hospital Acquired Conditions Reduce Medicare Reimbursement on October 1, 2008

Are you confused about the difference between the National Quality Forum's twenty-eight "never" events and the eight (or more) events for which CMS will begin limiting reimbursement on October 1, 2008?  I was. 

Here's the scoop:

CMS Hospital Acquired Condition (HAC) initiative, begins October 1, 2008

Medicare will no longer pay the hospital at a higher rate for the original eight conditions or any conditions added to the list in the final rule, if they were acquired during the hospital stay.

These events, if hospital acquired, will qualify for decreased Medicare reimbursement as of October 1, 2008:

1. Object inadvertently left in after surgery
2. Air embolism
3. Blood incompatibility
4. Catheter associated urinary tract infection
5. Pressure ulcer (decubitus ulcer)
6. Vascular catheter associated infection
7. Surgical site infection- Mediastinitis (infection in the chest) after coronary artery bypass graft surgery
8. Certain types of falls and trauma

CMS is proposing to expand the list of conditions that need to be reported if present when a patient is first admitted and is seeking public comment on whether they should be added to the list in the final rule to be announced later in 2008: 

1. Surgical site infections following certain elective procedures
2. Legionnaires’ disease (a type of pneumonia caused by a specific bacterium)
3. Extreme blood sugar derangement
4. Iatrogenic pneumothorax (collapse of the lung)
5. Delirium
6. Ventilator-associated pneumonia
7. Deep vein thrombosis/Pulmonary Embolism (formation/movement of a blood clot)
8. Staphylococcus aureus septicemia (bloodstream infection)
9. Clostridium difficile associated disease (a bacterium that causes severe diarrhea and more serious intestinal conditions such as colitis)

CMS Proposes to Expand Quality Program for Hospital Inpatient Services in 2009

And here are the 28 "Never" Events from the National Quality Forum,which contain some overlap with the CMS list, but are not the same. 

1. Artificial insemination with the wrong donor sperm or donor egg
2. Unintended retention of a foreign object in a patient after surgery or other procedure
3. Patient death or serious disability associated with patient elopement (disappearance)
4. Patient death or serious disability associated with a medication error (e.g., errors involving the wrong drug, wrong dose, wrong patient, wrong time, wrong rate, wrong preparation or wrong route of administration)
5. Patient death or serious disability associated with a hemolytic reaction due to the administration of ABO/HLA-incompatible blood or blood products
6. Patient death or serious disability associated with an electric shock or elective cardioversion while being cared for in a healthcare facility
7. Patient death or serious disability associated with a fall while being cared for in a healthcare facility
8. Surgery performed on the wrong body part
9. Surgery performed on the wrong patient
10. Wrong surgical procedure performed on a patient
11. Intraoperative or immediately post-operative death in an ASA Class I patient
12. Patient death or serious disability associated with the use of contaminated drugs, devices, or biologics provided by the healthcare facility
13. Patient death or serious disability associated with the use or function of a device in patient care, in which the device is used or functions other than as intended
14. Patient death or serious disability associated with intravascular air embolism that occurs while being cared for in a healthcare facility
15. Infant discharged to the wrong person
16. Patient suicide, or attempted suicide resulting in serious disability, while being cared for in a healthcare facility
17. Maternal death or serious disability associated with labor or delivery in a low-risk pregnancy while being cared for in a health care facility
18. Patient death or serious disability associated with hypoglycemia, the onset of which occurs while the patient is being cared for in a healthcare facility
19. Death or serious disability (kernicterus) associated with failure to identify and treat hyperbilirubinemia in neonates
20. Stage 3 or 4 pressure ulcers acquired after admission to a healthcare facility
21. Patient death or serious disability due to spinal manipulative therapy
22. Any incident in which a line designated for oxygen or other gas to be delivered to a patient contains the wrong gas or is contaminated by toxic substances
23. Patient death or serious disability associated with a burn incurred from any source while being cared for in a healthcare facility
24. Patient death or serious disability associated with the use of restraints or bedrails while being cared for in a healthcare facility
25. Any instance of care ordered by or provided by someone impersonating a physician, nurse, pharmacist, or other licensed healthcare provider
26. Abduction of a patient of any age
27. Sexual assault on a patient within or on the grounds of the healthcare facility
28. Death or significant injury of a patient or staff member resulting from a physical assault (i.e., battery) that occurs within or on the grounds of the healthcare facility

Comments

[Thomas Sharon, R.N., M.P.H]

Here is some information on the risks of bedsores that might be useful. More at http://nursetom.com

In making the assessment, your admitting nurse must determine whether anyone or more of the following risk factors exist:

age over 60
spinal cord paralysis
stroke
nervous system disease
poor circulation
diabetes
confined to bed
altered level of consciousness
confusion
bladder incontinence
bowel incontinence
diarrhea
anemia
dehydration
malnutrition
obesity
emaciation
reduced mobility (traction or body cast)

The usual procedure is to assign a value of 1 to each risk factor and add up those that exist. The totals then translate to one of the three levels of risk as follows: 0 to 6 indicates low risk, 7 to 13 indicates moderate risk, 14 to 18 indicates high risk. The parts of the body that are susceptible to pressure ulcers are the heels, ankles, knees, buttocks, tailbone, lower spine, shoulder blades, ears, and back of the head.

[Thomas Sharon, R.N., M.P.H]

Hospital-acquired contagions account for about one half of all hospital complications. Therefore, we are dealing with a problem on a massive scale.

There are two basic pieces to learning the cause and control of this dilemma: (1) It is the nature of the beast - infected people go to hospitals because that is where they need to be. (2) Human behavior plays the largest role in the spread of infectious organisms.

There are identifiable standards of care to prevent the spread of communicable diseases in hospitals and to prevent infections of various parts of the body arising from sloppy technique. This is an area of provable negligence that often goes unnoticed.

[x-ray fluorescence]

Hi,
very nice informative post.Thanks for posting such a useful information with us..