CMS’ Final HAC Rule Baffles Hospitals

Cheryl Clark, June 9, 2011

The Obama administration last week released another health reform jigsaw puzzle piece when it issued its final rule governing Medicaid payment adjustments for preventable medical errors.

But several hospital representatives I've spoken with say they're baffled by what the rule requires.  And as I read through the rule's 122 pages, I was confused as well.

"Your confusion is not unfounded," Beth Feldpush, senior associate director for policy at the American Hospital Association, assured me in an interview. "It's one of the challenging things...: There's a lot in there that's unclear."

Feldpush explains that with this rule, the Centers for Medicare & Medicaid Services appears to be giving states tremendous flexibility to interpret what a healthcare-associated condition (HAC) is and isn't, and what the expanded care necessitated by that unfortunate event includes and costs.

States must use Medicare's list of HACs as a base: retained surgical object, air embolism, blood incompatibility, stage III and IV pressure ulcers, falls and trauma, poor glycemic control, catheter-associated urinary tract, vascular catheter-associated and surgical site infections, and deep vein thrombosis.

But they can add newly termed "other provider-preventable conditions," or "OPPCs," as they see fit, as long as the new list includes, wrong procedure, wrong body part, or wrong patient as an OPPC base.
Interpreted one way, the rule could pave a path for states to augment their damaged budgets by avoiding paying state Medicaid funds for a lot of hospital care that they determine is necessitated by a hospital error, Feldpush says.

Some states could use this "as a means to really recoup some cost savings," she said. They could save the money perhaps for other Medicaid services, or use it for other state needs.


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