WASHINGTON – New rules proposed a week ago by the U.S. Centers for Medicare and Medicaid Services would add nine conditions to the list of preventable problems and hospital-acquired complications that Medicare will not pay hospitals to treat.
Medicare generally pays a set amount for each procedure or condition, but it also pays hospitals extra to offset the cost of complications. Last August, the CMS said it would stop making those extra payments when the problems “could reasonably have been prevented,” and it barred the facilities from billing patients for treatment of hospital-acquired complications.
The initial list included three “never events” – objects left in the body during surgery, air embolisms and blood incompatibility – as well as falls; urinary-tract infections related to improper use of catheters; pressure ulcers; catheter-related vascular infections; and mediastinitis, an infection that can develop after heart surgery.
The conditions that the CMS now wants to add to the list include surgical-site infections after certain elective procedures; Legionnaire’s disease, which is a type of pneumonia; extreme blood-sugar derangement; collapsed lungs; delirium; ventilator-associated pneumonia; deep-vein thrombosis or pulmonary embolisms; bloodstream infections; and clostridium difficile-associated disease, which can involve severe diarrhea, colitis and other issues.
The CMS estimated that the proposed rule would save Medicare $50 million per year.
“CMS is taking aggressive actions to ensure that beneficiaries get safe, high-quality and efficient care from their health care providers, and the actions we are announcing today build on our efforts,” Acting Administrator Kerry Weems said in announcing the proposal.
“The status of the Medicare Hospital Insurance Trust Fund requires us to find the best solutions to ensure that Medicare stays strong while paying providers appropriately for the care they deliver,” he added. “The reforms we are proposing in this rule should lead to greater value for Medicare beneficiaries and the Medicare program.”
In addition, the CMS last week proposed adding 43 new quality measures on which hospitals would have to report data to receive a full inflation update in 2010, for a total of 73. Hospitals that didn’t comply would lose 2 percentage points on any payment increase.
A full 15 of the new measures involve cardiac surgery, and another 10 involve quality and safety measures developed by the Agency for Healthcare Research and Quality. The rest involve a type of embolism, stroke measures, hospital readmissions and nursing care.
The new rule would apply to more than 3,500 acute-care hospitals paid under the Inpatient Prospective Payment System, the one that sets a specific rate for each diagnosis, rather than paying for the actual costs of each case.
Consumers have access to the reported data on quality measures through Medicare’s Web-based tool, Hospital Compare, which the U.S. Centers for Medicare and Medicaid Services (www.cms.hhs.gov) have been expanding to meet a growing demand.
Locally, the nonprofit Lifespan health system has set up a direct link from its own Web site to help consumers access quality of care data for its member hospitals.
