Top 10 Quality Issues for 2013

Cheryl Clark, January 7, 2013

Quality officials should see this year as among the most interesting, albeit nerve-racking, for acute care hospitals and doctors as major provisions move closer toward official policy under the Patient Protection and Affordable Care Act.  

It's impossible to know or predict them all. But these few, at the very least, will send many hospital and physician leaders reaching for their Pepcid.

For all these thought-provoking issues, there are hopes for greater efficiency, safety, transparency and overall quality of care. But hospital officials should not be blamed if they worry about unintended consequences, and whether they have the resources to manage each and every program.

While some of the policies won't impact payment or quality reporting requirements until FY 2015, performance periods on which hospitals will be judged may begin much sooner. The clock is ticking.

1. Cracking HACs
Section 2008 of the Patient Protection and Affordable Care Act says that payments for the care of Medicare patients discharged as of Oct. 1, 2014, will be reduced based on each hospital's track record of causing or failing to prevent hospital-acquired conditions (HACs) to their patients.

Hospitals will be divided into performance groups, depending on the acuity of their patient mix. Those in the highest quartile of performance, which in this case means those that had the worst number of HACs, will be penalized 1% of their Medicare base DRG rate.

It remains unclear which hospital-acquired conditions the Centers for Medicare & Medicaid Services will include in the list, or during what time period hospitals will be judged. But it may be assumed that performance during all or a portion of 2013 and 2014 could figure in the equation.

These conditions listed on Hospital Compare are obvious candidates:

  • Objects accidentally left in the body after surgery
  • Air bubble in the bloodstream
  • Mismatched blood types
  • Severe pressure sores, usually defined as those classified as Stage III or IV.
  • Falls and injuries in the hospital
  • Blood infection from a catheter in a large vein
  • Infection from a urinary catheter
  • Signs of uncontrolled blood sugar

As of 2008, federal regulation prohibits additional care necessitated by any of those events from being reimbursed when they occur in a Medicare patient. But look for providers to be penalized when they occur in Medicaid patients as well.

Federal officials will send each hospital an updated "confidential report" regarding the number of hospital acquired conditions they had during the performance period.


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