Reducing HACs
Reducing hospital-acquired infections has become a top priority for hospitals in the face of new penalties from CMS.
It’s an irony that one of the most serious risk factors for deteriorating health in the U.S. is admission to a hospital. In fact, one in 25 people admitted to hospitals acquires infections during their stay that were not present when they first sought medical intervention, according to the
Hospital acquired infections (HAIs) caused illness in 722,000 patients in 2011, resulting in loss of life in 75,000 cases. Other causes of potential harm are not so easy to quantify. As Ashish Jha, MD, professor of health policy at the
Jha says until recently, healthcare payment policies have, through a perverse incentive, reinforced this reality. That’s because hospitals previously were able to bill payers for treating Hospital Acquired Conditions (HACs), sometimes at rates higher than the initial condition that brought the patient in for medical care.
In an effort to flip that model, the Centers for Medicare and Medicaid Services (CMS) created the
Penalties for hospitals
The HAC Reduction Program revolutionizes the payment system for patient care in a way intended to galvanize attention on the safety aspect of the quality of patient care and not just on the quantity of care patients receive, Jha explains. In the past, he notes, patients’ cases were assigned to one of the various diagnosis-related groups based on the medical condition coded in the patient’s record. Payments were tied to the categorization of the case. If patients experienced an event that might prove more costly to treat than the original condition with which they presented, their cases were simply moved to the higher pay scale and insurers such as Medicare were billed accordingly.
Related:
The HAC Reduction Program, established by the Affordable Care Act (ACA), penalizes hospitals in the lowest performing quartile for HACs, imposing a 1% across-the-board reduction against overall Medicare payments starting in fiscal 2015. Deductions are calculated and assessed after any adjustments for value-based purchasing programs or other federal initiatives that affect the institution’s net Medicare payment.
Jha says the initiative, along with value-based purchasing, represents a first salvo “in the federal government’s attempt to connect financial realities to the safety and quality of care patients receive in hospitals.”
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