Dec 21, 2015

Florida Hospitals Payments Penalized for Hospital-Acquired Conditions

By on 4:40 AM

Hospitals have been closely scrutinized as part of the Affordable Care Act (ACA), which includes the Hospital-Acquired Condition (HAC) Reduction Program.

Beginning in fiscal year 2015, the program directed by the Centers for Medicare & Medicaid Services (CMS) reduces hospital payments by 1 percent for facilities that rank amongst the lowest performing 25 percent with respect to specific HACs.

The program's specific patient safety measures concern the following healthcare-associated infections (HAIs):
  • Central line-associated bloodstream infections (CLABSI);
  • Catheter-associated urinary tract infections (CAUTI);
  • Surgical site infections (colon surgeries and abdominal hysterectomies) (2016 addition);
  • Methicillin-resistant Staphylococcus aureus (MRSA) (2017 addition); and
  • Clostridium difficile infection (CDI) (2017 addition).
According to a Miami Herald report, 758 hospitals nationwide will be subjected to a 1 percent reduction in their Medicare payments for the federal fiscal year that runs through September 2016 (in fiscal year 2015, 724 hospitals were subject to a payment reduction). This includes seven South Florida hospitals.

While the goal of this program, including the reduction of payments, is to create improvement in patient safety and quality, hospitals that treat the sickest and therefore the riskiest patients will be penalized as an unintended consequence. The public needs to be cautious when interpreting the information while bearing in mind that hospitals are making the effort to reduce HAIs and progress occurs over time.

It is imperative for hospitals to remain vigilant in their efforts to prevent and reduce HACs and HAIs. These efforts should include use of an infection prevention risk assessment, conducting ongoing infection control education and always following proper safety guidelines and recommendations.


Phenelle Segal, RN, CIC, FAPIC

Phenelle Segal, RN, CIC, FAPIC, is the founder and president of Infection Control Consulting Services LLC (ICCS), which is based in Delray Beach, Florida. Phenelle has more than 30 years experience providing customized comprehensive infection control and prevention services to healthcare facilities nationwide. Her services focus on assisting hospitals, ambulatory surgery centers, dental office and oral surgery practices, doctor's offices, nursing homes to implement and maintain an infection control program that: complies with The Joint Commission (TJC), Centers for Medicaid and Medicare Services (CMS) and other regulatory agencies, respond to situations of noncompliance, and improve the processes for reducing risk.


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