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

Cheryl Clark, for HealthLeaders Media, September 5, 2013

Also, hospitals are required to self-report to state Medicaid agencies any incident involving a qualifying HAC.

3. Chicken Feed
Under the Patient Protection and Affordable Care Act starting on Oct. 1, 2014, or FY 2015, Medicare will financially punish hospitals with higher rates of central line-associated bloodstream infections [PDF], or CLABSI, as part of the value-based purchasing incentive program.

All eligible hospitals are required to relinquish into a pool an amount that is bound to be somewhat higher than $1.1 billion, the amount of the pool for FY 2014.

This money will be redistributed to hospitals based on their performance in three basic areas. Patient experience counts 30%, process of care measures count 40%, and five outcome measures, which include three measures of 30-day mortality, a composite safety score, and rates of CLABSI, count 30% with each of the five equally weighted at 6%

The precise algorithm is too complicated for this column, but the amount at risk for just those hospitals with high CLABSI rates is probably a mere $60 million, and higher performance in other parts of the VBP equation may mute that impact to any one hospital.

4. Peanuts
Under the Affordable Care Act, effective with patient discharges beginning Oct. 1, 2014, the Hospital-Acquired Condition penalty kicks in. Any hospital whose rates of hospital-acquired conditions are among the highest 25% will see its Medicare DRG rate, which for most hospitals amounts to roughly half their total revenue, cut by 1%.

The algorithm is divided into two domains, the first of which has eight measures, two of which deal with hospital-acquired infections—postoperative sepsis and central venous catheter-related bloodstream infections. Domain one counts 35%.

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