CMS proposed rule on Hospital "Never Events"

 

On April 14, CMS posted the Hospital 2009 IPPS Notice of Proposed Rulemaking (NPRM) which includes expansion of the list of its Hospital Acquired Conditions (HAC) for non-payment (so called "never events").  Comments are due June 13.  While the rule affects hospital DRG payments only, there are significant implications for physician documentation on admission and patient care. 

 

Nine new conditions have been proposed for nonpayment to hospitals in 2009.  These are: 

  • Surgical site infections following certain elective procedures
  • Legionnaires’ disease (a type of pneumonia caused by a specific bacterium)
  • Extreme blood sugar derangement
  • Iatrogenic pneumothorax (collapse of the lung)
  • Delirium
  • Ventilator-associated pneumonia
  • Deep vein thrombosis/Pulmonary Embolism (formation/movement of a blood clot)
  • Staphylococcus aureus septicemia (bloodstream infection)
  • Clostridium difficile associated disease (a bacterium that causes severe diarrhea and more serious intestinal conditions such as colitis)

The AMA will be drafting comments and would welcome input from state medical societies and specialty societies.  We also request specific clinical input on these conditions to inform our comments on their appropriateness for inclusion for nonpayment in 2009.  Please contact Carol Vargo, Assistant Director, Federal Affairs at Carol.Vargo@ama-assn.org or 202-789-7492 with any comments or questions.   

 

Click here for the CMS press release. 

 

 

Below is a PDF file of the HAC section of the proposed rule that we have extracted from the larger IPPS rule.

 

In addition, for your information, CMS is proposing an expansion of the hospital quality measure reporting program, which reduces the amount a hospital is paid if it does not participate in the reporting of standardized measures.  Hospitals are currently required to report on 30 quality measures.  These measures are publicly reported on the CMS Hospital Compare website.  CMS is proposing adding 43 new measures to the list for hospitals in order for them to get the full inflation update for 2010.  The proposed new measures are on the following topics:

  • Surgical Care Improvement Project ( 1 new measure)
  • Hospital readmissions (3)
  • Nursing care (4)
  • Patient Safety Indicators developed by AHRQ (5)
  • Inpatient Quality Indicators developed by AHRQ (4)
  • Venous Thromboembolism (6)
  • Stroke (5)
  • Cardiac Surgery (15)


HAC 2009 Proposed Rule (pdf document)

 

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