A new study shows Medicare's policy against paying for hospital-acquired conditions (HAC) will only save $1.1 million to $2.7 million.
California researchers conducted the study, which analyzed discharge data from California Medicare beneficiaries in 2006, looking for six conditions the authors deemed definable. Out of the total 767,995 cases, there were 828 cases of those conditions, and 26 would have been subject to lower payments, according to the Wall Street Journal.
"If it's designed to recapture money, it's poorly designed," says Keith Siddel, PhD (c), founder, president, and CEO of HRM in Creede, CO, a national healthcare financial service organization.
A patient's condition upon admission usually generates multiple codes, so if a patient develops a HAC, the nonpayment for that condition will not heavily impact the total reimbursement because of legitimate payment for the rest of the codes, Siddel says.
For example, if a patient develops a urinary tract infection (UTI) in the hospital, CMS will not pay that hospital for treatment of that condition. But if that case includes 10 or 15 other codes, dropping one code for a UTI will not decrease the payment by much.
Siddel says he has tested the impact of HACs for clients and came up with similar "marginal results" as the California researchers.
Although CMS officials acknowledged that projected savings are not large, they suggested the study may be "limited and speculative." They added the penalties have been effective in changing behavior and improving hospital care.