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Financial Incentives for Preventing HAIs Don't Add Up to Much

Cheryl Clark, for HealthLeaders Media, September 5, 2013

According to page 2144 of the 2014 final IPPS rule issued Aug. 19, the Centers for Medicare & Medicaid Services estimates the total federal savings from the DRA program are as follows:

FY 2014 — $26 million
FY 2015 — $28 million
FY 2016 — $30 million
FY 2017 — $33 million
FY 2018 — $36 million

These amounts are represent total avoided payments for all 10 hospital acquired conditions, including air embolism, blood incompatibility, pressure ulcers, falls and trauma, manifestations of poor glycemic control, and deep vein thrombosis and pulmonary embolism following total hip or knee replacement surgeries.

Avoided spending for three types of infections could be a mere $9 million to $11 million, amounts that dissipate when they are spread out among a subset of 3,500 hospitals.

2. Mickey Mouse
Though Medicare no longer pays for additional care required because of a hospital-acquired condition, there was no such requirement under Medicaid, which is funded by a roughly 50/50 combination of state and federal funds, and states generally set their own coverage rules. Only half of the states in 2011 had a no HAC payment rule, and those that did widely varied.

That changed as of July 6, 2011, when CMS announced that, under authority of the ACA section 2702, all states had to adopt similar HAC no-payment policies. Federal payments would not go to any state for any amounts expended for providing medical assistance for a healthcare-acquired condition.

But here again, the amount is miniscule. CMS estimated savings for all five years, across all providers, from 2011, 2012, 2013, 2014 and 2015, is a whopping $20 million for the federal share and $15 million for the state share.

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