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Expansion of Hospital Quality Program Is Proposed

May 27, 2008:
The Centers for Medicare & Medicaid Services (CMS) is proposing to expand the list of conditions that 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.

Additionally, the agency is proposing to add 43 new quality measures that hospitals will have to report data on to receive the full annual payment update for their services. The proposed rule would apply to services provided to patients who are discharged from the hospital during fiscal 2009, which begins on October 1, 2008.

The rules proposed expanding two key Medicare initiatives that begin to link payments for services to the 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 he or she didn’t have when first admitted to the hospital and that have been determined to be reasonably preventable by following generally accepted guidelines.

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, including:
  • 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)
CMS is also proposing expanding the hospital quality measure reporting program. This program is designed to reduce 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 fiscal 2009 payment rates. CMS is proposing to add 43 quality measures to the list, bringing the total number of measures in fiscal 2009 to 73. The proposed additions include 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
  • Stroke measures (STK)—5
  • Cardiac surgery measures—15
Deborah C. Hall
Clinical/Technical Editor


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