MarketWatch - Medicare's policy not to pay for treating hospital-acquired conditions: The impact

Health Affairs

Volumn 28, Issue 5, 2009, Pages 1485-1493

  McNair, Peter D ^c   Luft, Harold S ^a   Bindman, Andrew B ^b  

^a PALO ALTO MEDICAL FOUNDATION RESEARCH INSTITUTE   (United States)

^b UNIVERSITY OF CALIFORNIA   (United States)

^c NONE

Author keywords

[No Author keywords available]

Indexed keywords

ARTICLE; HEALTH CARE DELIVERY; HEALTH CARE POLICY; HEALTH CARE QUALITY; HOSPITAL DISCHARGE; HOSPITAL READMISSION; IATROGENIC DISEASE; MEDICARE; PUBLIC OPINION; REIMBURSEMENT; UNITED STATES; CROSS INFECTION; ECONOMICS; GOVERNMENT; HUMAN; LEGAL ASPECT;

CALIFORNIA; CENTERS FOR MEDICARE AND MEDICAID SERVICES (U.S.); CROSS INFECTION; HEALTH POLICY; HUMANS; MEDICARE; PATIENT DISCHARGE; REIMBURSEMENT MECHANISMS; UNITED STATES;

EID: 70349227003     PISSN: 02782715     EISSN: 15445208     Source Type: Journal    
DOI: 10.1377/hlthaff.28.5.1485     Document Type: Article

References (23)

1. Medicare Payment Advisory Committee. Hospital acute inpatient services payment system [Internet]. Washington (DC): MedPAC; 2007 Oct [cited 2009 Jun 24]. Available from: http://www.medpac.gov/documents/MedPAC-Payment-Basics-07- hospital.pdf
2. Ashby J, Stensland J. Hospitals: assessment of payment adequacy. MedPAC public meeting, 2007 December 6-7; Washington, DC [Internet]. Washington (DC): MedPAC; 2007 Dec 6-7 [cited 2009 Jun 24]. Available from: http://www.medpac.gov/ transcripts/1207-hospital-JA-pres.pdf.
3. Ehsani JP, Jackson T, Duckett SJ. The incidence and cost of adverse events in Victorian hospitals 2003-2004. Med J Aust. 2006;184(11):551-555
4. Wilson RM, Runciman WB, Gibberd RW, Harrison BT, Newby L, Hamilton JD. The Quality in Australian Health Care Study. Med J Aust. 1995; 163(9):458-471
5. Open letter. Paying for performance: should Medicare lead? Health Aff (Millwood). 2003;22(5):8-10.
6. Part II, U.S. Department of Health and Human Services, Centers for Medicare and Medicaid Services, 42 CFR Parts 412, 413, 415 et al., Medicare program; proposed changes to the hospital inpatient prospective payment systems for acute care hospitals and fiscal year 2010 rates and to the long-term care hospital prospective payment system and rate, year 2010 rates; proposed rule. Fed Regist. 2009 May 22;74(98):24079-128. In 2009, after we had modeled the policy,Medicare added four hospital-acquired conditions: poor glycemic control, postoperative infection for orthopedic and bariatric surgery, and postoperative DVT.
7. California Office of Statewide Planning and Development. Healthcare Information Division Public Data Set [Internet]. Sacramento (CA): OSHPD; [cited 2009 Jun 24]. Available from: http://www.oshpd.ca.gov/HID/Products/ PatDischargeData/PublicDataSet/index.html
8. DHHS. Impact file for IPPS FY 2006 final rule [Internet]. Baltimore (MD): Centers for Medicare and Medicaid Services; [cited 2009 Jun 24]. Available from: http://www.cms.hhs.gov/AcuteInpatientPPS/FFD/itemdetail.asp?filterType= none&filterByDID=0&sortByDID=2&sortOrder=descending&itemID= CMS022536&intNumPerPage=10
9. Medicare reduces payment for discharges that are transferred to another inpatient PPS acute hospital or, in 182 DRGs, transferred to another postacute care facility, and where the length-of-stay for the discharge is less than the DRGspecific geometric mean length-of-stay.
10. For example, an adult patientwith a diagnosis of 550.10 - "Unilateral inguinal hernia with obstruction," who undergoes a repair procedure, 530.0 - "Unilateral inguinal hernia repair," is allocated to DRG 162 - "Inguinal and femoral hernia procedures age 17 without complication nor comorbidity." If this case were complicated by a diagnosis of 5601 - "Paralytic ileus," it is allocated to DRG 161 - "Inguinal and femoral hernia procedures age 17 with complication or comorbidity." However, if the casewere complicated by 49390 - "Asthmawithout status asthmaticus," it is not reallocated (that is, "paralytic ileus" is a critical code that triggers reallocation; "asthma without status asthmaticus" alone would not).
11. Difference of two proportions (shrunken estimates) test (α = 0.05).
12. Altman DG, Machin D, Bryant TN, Gardner MJ. Statistics with confidence. 2d ed. London (U.K.): BMJ Books; 2000.
13. The most recent version of the NIS available at time of publication was 2005. Not all states contributing to the NIS collect condition present on admission (CPOA).
14. These discharges were predominantly undertaken by health maintenance organizations.
15. Although accounting for 13.8 percent of facilities, they had only 3.5 percent of Medicare patients.
16. In twenty-three cases, the hospital-acquired condition was catheter-associated UTI; in four, decubitus ulcer.
17. Simborg DW. DRG creep: a new hospital-acquired disease. N Engl J Med. 1981;304(26):1602-1604
18. Zhan C, Friedman B, Mosso A, Pronovost P. Medicare payment for selected adverse events: building the business case for investing in patient safety. Health Aff (Millwood). 2006;25(5):1386-1393 (Pubitemid 44497639)
19. Zhan C, Elixhauser A, Friedman B, Houchens R, Chiang YP. Modifying DRG-PPS to include only diagnoses present on admission: financial implications and challenges. Med Care. 2007;45(4):288-291
20. McNair P, Borovnicar D, Jackson T, Gillett S. Prospective payment to encourage system wide quality improvement. Med Care. 2009;47(3):272-278
21. This may have to exclude replacement of valves damaged by Staphylococcus aureus infection.
22. Melnick GA, Fonkych K. Hospital pricing and the uninsured: do the uninsured pay higher prices? Health Aff (Millwood). 2008;27(2):w116-22.
23. New York State Department of Health. Medicaid to cease reimbursement to hospitals for 'never events' and avoidable errors [Internet]. Albany (NY): Department of Health; 2008 Jun 5 [cited 2009 Jun 25]. Available from: http://www.health.state.ny.us/press/releases/2008/2008-06-05-medicaid-cease- paying-never-events.htm