CMS Proposes Rules for Hospital-Acquired Illnesses
The Centers for Medicare and Medicaid Services (CMS) issued a proposed rule that would result in nonpayment for hospital-acquired illnesses. The CMS said the following in a press release about the proposed rule:
CMS is proposing to expand the list of conditions which are reasonably preventable through proper care and for which Medicare will no longer pay at a higher rate if the patient acquires them during a hospital stay. In addition, CMS is adding 43 new quality measures for which hospitals will have to report data in order to receive the full annual payment update for their services.
...
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.
...
Comments on the proposed rule will be accepted through June 13. CMS will respond to comments in a final rule to be issued on or before August 1, 2008.
More information can be found here.