How IPPS Proposed Rules Would Affect Quality Measures
5. Hospital Acquired Conditions (HAI)
CMS proposes to add two conditions to the list of Hospital Acquired Conditions for discharges occurring on or after Oct. 1, 2012.
The first includes surgical site infections, usually Staphylococcus aureus, following a cardiac implantable electronic device (CIED) procedure.
The proposed rule states that at least 500,000 devices are implanted each year and 70% of the recipients are Medicare eligible. However, infections resulting from these implants are increasing faster than the rate of increase in the procedures, the agency says.
These infections often necessitate surgical removal of the device, anesthesia, intravenous antibiotics, and time in the ICU. Between 5% and 8% of patients die in the hospital and 17.5% to 35.1% within a year.
And they're expensive. CMS said studies show that the cost of treating these complications is steep, averaging "$28,676 to $53,349" and as high as high as $72,485 per case.
But these infections are reasonably preventable through precautions such as prophylactic antibiotics, which one study showed can reduce CIED-related infections in 81% of patients who received them.
The second HAI condition is the incidence of pneumothorax with venous catheterization. This happens when a medical intervention, such as a needle placement for central line catheter guidance, inadvertently results in collapse of the lung.
However, use of portable ultrasound devices can guide placement to avoid these complications.
As usual, CMS seeks comments and will issue a final rule by August. The proposed rule may be downloaded from the Federal Register.
Cheryl Clark is senior quality editor and California correspondent for HealthLeaders Media. She is a member of the Association of Health Care Journalists.
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