No pay for more never events: CMS proposes more never events and more hospital reporting obligations

As part of the proposed 2009 IPPS regulation published in the April 30 Federal Register, CMS has issued a proposed expanded list of never events, and also proposed increasing hospital reporting obligations.  The CMS press release explains it all for you:

The rules proposed by CMS expand two key initiatives that begin to link payments for health care services to quality of care – the Hospital-Acquired Conditions and the Hospital Quality Measure Reporting initiatives.  Under the HAC initiative, beginning October 1, 2008, Medicare will no longer pay hospitals at a higher rate for the increased costs of care that result when a patient is harmed by one of several conditions they didn’t have when they were first admitted to the hospital and that have been determined to be reasonably preventable by following generally accepted guidelines.

The HAC provisions in Medicare regulations required hospitals to begin reporting on their Medicare claims on October 1, 2007, whether certain specified diagnoses were present when the patient was admitted.  The first eight conditions, which were selected last year because they greatly complicate the treatment of the illness or injury that caused the hospitalization, resulting in higher payments to the hospital for the patient’s care by both Medicare and the patient, were:

    * Object inadvertently left in after surgery
    * Air embolism
    * Blood incompatibility
    * Catheter associated urinary tract infection
    * Pressure ulcer (decubitus ulcer)
    * Vascular catheter associated infection
    * Surgical site infection- Mediastinitis (infection in the chest) after coronary artery bypass graft surgery
    * 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 this year.  The list in the proposed rule includes:

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

Beginning 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.

The second initiative CMS is proposing is the expansion of the hospital quality measure reporting program, which reduces the amount a hospital is paid if it does not participate in the voluntary reporting of standardized quality measures.  These are measures that are publicly reported on Hospital Compare.  Hospitals are currently required to report 30 quality measures on their claims for Medicare inpatient services to qualify for a full update to their FY 2009 payment rates.  CMS is proposing to add 43 quality measures to the list in order to get the full inflation update for FY 2010, bringing the total number of measures in FY 2009 to 73.  The proposed additions include the measures of the following types:

    * Surgical Care Improvement Project (SCIP) – 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 thromboembolism measures (VTEs) – 6

You can read more on never events in other posts here at HealthBlawg.

— David Harlow