Florida Hospitals Payments Penalized for Hospital-Acquired Conditions

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
Dec 21, 2015

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Florida Hospital Association Reports Infection Prevention Improvement Statewide

Hospitals nationwide have been intricately involved in quality assurance performance improvement efforts (QAPI) for several years. In 2012, seventy-seven Florida hospitals, under the direction of the Florida Hospital Association (FHA), enrolled in the largest hospital quality improvement project in the state in partnership with the American Hospital Association, Centers for Medicare and Medicaid Services (CMS) and the Hospital Engagement Network (HEN). They set a goal of achieving a 40% reduction in harm and a 20% reduction in preventable readmissions within a three-year period.

The project was extensive, with hospitals working through the FHA HEN providing many resources to fulfill the requirements. The focus was placed on 11 major areas that are notoriously for having the highest reported incidences of preventable harm. Four of these areas related to healthcare-acquired infections (HAIs), including central line-associated bloodstream infection (CLABSI), catheter-associated urinary tract infection (CAUTI), surgical site infection (SSI) and ventilator-associated pneumonia (VAP).

According to a recent FHA report (pdf), results on this initiative are very encouraging thus far, and include significant improvement in reduction of HAIs. Within the 11 areas of focus, it was reported that 27,500 cases of harm were prevented. The overall harm rate was reduced by 54% and an estimated $170 million in healthcare costs were avoided.

Of note in the report is a special mention of CLABSI and CAUTI reduction: “In addition to the 11 targets, FHA HEN hospitals also worked on reducing dangerous infections such as Clostridium difficile (C. diff), Methicillin-resistant Staphylococcus Aureus (MRSA), sepsis and several other complications."

With Florida's progress toward infection prevention and eliminating patient harm, including HAIs, the state is continuing collaborative efforts as there remains much work needed to continue progress in the area of patient safety. HEN 2.0 will be launching later in 2015, with Florida hospitals striving for the ultimate goal of "safest in the country."

Phenelle Segal
Mar 19, 2015

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