CMS to Penalize for High HAC

New Ruling: Medicare Will Impose Financial Penalties on Hospitals Based on HAC Performances

The ruling is here and its ramifications could be far-reaching. On August 2, 2013, the Centres for Medicare & Medicaid Services (CMS) released its finalised payment reduction programme for hospital-acquired conditions (HAC). Simply put: 1% of overall inpatient payments are at risk for hospitals in the bottom 25 percentile of those performing poorly with regard to HACs.

Fortunately, rates of HAC-listed iatrogenic pneumothorax have been shown to decrease when ultrasound guidance is used during CVCs. Also on the HAC list is central line-associated blood stream infections (CLABSI). Studies have shown that, when used in conjunction with a five-point central line bundle for patient safety, ultrasound guidance during the laying of central lines can help reduce some of the complications leading to CLABSI. Over time—and in light of this new ruling—these ameliorative steps could have a significant impact on CMS payments.

Below is a selected portion of the CMS press release dealing with the HAC ruling. You can read the full CMS Press Release here.

CMS final rule to improve quality of care during hospital inpatient stays

OVERVIEW: On August 2, 2013, the Centres for Medicare & Medicaid Services (CMS) issued a final rule [CMS-1599-F] updating Medicare payment policies and rates under the Inpatient Prospective Payment System (IPPS) and Long-Term Care Hospitals Prospective Payment System (LTCH PPS) in fiscal year (FY) 2014.

The final rule, which will apply to approximately 3,400 acute care hospitals and approximately 440 LTCHs, will affect discharges occurring on or after October 1, 2013...


The FY 2014 hospital payment rule finalises the general framework for the Hospital-Acquired Condition (HAC) Reduction Programme for the FY 2015 implementation. Section 3008 of the Affordable Care Act requires CMS to establish a programme for IPPS hospitals to improve patient safety, by imposing financial penalties on hospitals that perform poorly with regard to hospital-acquired conditions. HACs are conditions that patients did not have when they were admitted to the hospital, but which developed during the hospital stay.

Under the HAC Reduction Programme, hospitals that rank in the lowest-performing quartile of hospital-acquired conditions will be paid 99 percent of what otherwise would have been paid under IPPS, beginning in FY 2015. The rule finalises the quality measures and the scoring methodology to determine this quartile, as well as the process hospitals will use to review and correct their data.

In the first year of the programme, FY 2015, CMS will use measures that are part of the IQR programme. The HAC measures will consist of two domains of measure sets.

Domain 1 will include the Agency for Health Care Research and Quality (AHRQ) composite PSI #90. This composite measure includes: pressure ulcer rate; volume of foreign object left in the body; iatrogenic pneumothorax rate; central venous catheter-related blood stream infection rate; postoperative hip-fracture rate; perioperative haemorrhage or hematoma rate; postoperative physiologic and metabolic derangement rate; postoperative respiratory failure rate; postoperative pulmonary embolism or deep vein thrombosis rate; postoperative sepsis rate; postoperative wound dehiscence rate; and accidental puncture or laceration rate.

Domain 2 measures consist of two healthcare-associated infection measures developed by the Centres for Disease Control and Prevention’s (CDC) National Health Safety Network: Central Line-Associated Blood Stream Infection and Catheter-Associated Urinary Tract Infection.

Hospitals will be given a score for each measure within the two domains. A domain score will be calculated—with Domain 1 weighted at 35 percent and Domain 2 weighted at 65 percent—to determine a total score under the programme. Risk factors such as the patient’s age, gender, and comorbidities will be considered in the calculation of the measure rates so that hospitals serving a large proportion of sicker patients will not be penalized unfairly. Hospitals will be able to review and correct their information.

Read the full CMS Press Release


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