HEALTHCARE REFORM Hospital-acquired Conditions and Infections - - PowerPoint PPT Presentation

STREAMLINING HEALTHCARE

DISTRIBUTION DISTRIBUTION

HEALTHCARE REFORM

Hospital-acquired Conditions and Infections Policies

AUGUST 2011

The enclosed slides are intended to provide you with an overview of healthcare reform reimbursement policies regarding hospital-acquired conditions (HACs) and infections (HAIs). This tool is designed to help distributors and manufacturers understand how the new payment policies and programs fit together and how they will impact hospitals. For example, there are multiple programs set up to reduce payments to hospitals for HACs or HAIs and some infections could be much more costly than others. This is one of the many healthcare reform resources HIDA has developed. For more information on healthcare reform, visit www.HIDA.org/Reform, or contact HIDA Government Affairs at (703) 549-4432.

STREAMLINING HEALTHCARE

DISTRIBUTION DISTRIBUTION

HACs vs. HAIs

• Hospital-acquired conditions (HACs)

Serious conditions that patients contract during a hospital stay

• Hospital-acquired infections (HAIs)

Serious infections that patients contract during a hospital stay

• Healthcare reform

includes a HAC reimbursement policy to incentivize hospitals to drastically reduce infection rates

All HAIs are HACs, but not all HACs are HAIs

HACs HAIs

STREAMLINING HEALTHCARE

DISTRIBUTION DISTRIBUTION

NO END-GAME FOR HACs

• Begins in 2015; the program continues indefinitely (as there is no

expiration or sunset date), no matter how low infection rates are in the future

• 1% cut across-the-board to hospitals in the top quartile of national

infection rates (infections and rates are to be determined in regulatory rulemaking process)

• Projected to save $1.4 billion over 10 years
• HHS required to submit a

report to Congress with with regard to establishing a HAC policy in post-acute settings

STREAMLINING HEALTHCARE

DISTRIBUTION DISTRIBUTION

MULTIPLE PENALTIES = 1 INFECTION*

A single infection could result in multiple penalties due to the implementation of additional programs that penalize for HACs (for example, value-based purchasing, Medicare and Medicaid policies to reduce preventable medical errors, and accountable care organizations)

* This table is meant to provide a snapshot of HAC/HAI only. Details on all the HAI quality measures, which include specific surgeries and patient safety indicators that affect market basket updates and value-based purchasing payments for hospitals, can be found on the Centers for Medicare and Medicaid Services (CMS) Web site at www.cms.gov. Direct links to the various programs are imbedded in the table above. ** CMS has not yet proposed regulations to implement infection policies included in healthcare reform.

Hospital-acquired Conditions Medicare

(not eligible for higher payment per IPPS)

Value-based purchasing 1% cut per health reform policy Medicaid preventable conditions Proposed ACO quality measures (FY2008) (FY2013) (FY 2015)** (July 1, 2012) (Jan. 1, 2012) Catheter associated UTI X X ? X X Surgical site infections X X ? X X Foreign object retained after surgery X X ? X X Air embolism X ? X X Blood incompatibility X ? X X Pressure ulcer stages III or IV X ? X X Falls and trauma X ? X X DVT/PE after hip/knee replacement X ? X X Manifestations of poor glycemic control X ? X X Ventilator associated pneumonia X ? MRSA X ? Clostridium difficile X ? Central line assoc. blood steam infection X