Medicare Proposes Adding Nine More Conditions To List Of Hospital Complications It Will Not Pay To Treat

Main Category: Medicare / Medicaid / SCHIP
Also Included In: Public Health
Article Date: 16 Apr 2008 - 12:00 PDT

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CMS officials on Monday proposed new rules that would add nine conditions to the list of preventable conditions that Medicare will no longer pay hospitals to treat, the AP/San Francisco Chronicle reports (Freking, AP/San Francisco Chronicle, 4/14). CMS in August 2007 announced that it no longer will reimburse hospitals for the treatment of certain "conditions that could reasonably have been prevented," and the facilities "cannot bill the beneficiary for any charges associated with the hospital-acquired complication." The conditions include: falls; mediastinitis, an infection that can develop after heart surgery; urinary tract infections that result from improper use of catheters; pressure ulcers; and vascular infections that result from improper use of catheters. In addition, the conditions include three "never events": objects left in the body during surgery, air embolisms and blood incompatibility (Kaiser Daily Health Policy Report, 8/20/07).

The nine preventable conditions proposed on Monday include:

• Surgical site infections following certain elective procedures;
  
  
• Legionnaire's disease;
  
  
• Extreme blood sugar derangement;
  
  
• Iatrogenic pneumothorax or collapsed lungs;
  
  
• Delirium;
  
  
• Ventilator-associated pneumonia;
  
  
• Deep vein thrombosis or pulmonary embolism;
  
  
• Staphylococcus aureus septicemia or bloodstream infection; and
  
  
• Clostridium difficile associated disease (CMS release, 4/14).

CMS estimates that the proposed rule will save Medicare $50 million annually during each of the next three years (AP/San Francisco Chronicle, 4/14).

Quality Reporting
CMS on Monday also proposed a regulation that would add 43 new quality measures that hospitals would have to report data on to receive a full inflation update in 2010. Under the proposal, hospitals would have to report on a total of 73 quality measures or face a loss of two percentage points in any payment increase. Acting CMS Administrator Kerry Weems on Monday said, "Medicare can and should take the lead in encouraging hospitals to improve the safety and quality of care and make better practices a routine part of the care they provide, not just to people with Medicare, but to every patient they treat." Don May, vice president of policy at the American Hospital Association, said that "the additional 43 measures go way beyond a reasonable increase for 2010." He added that a number of the measures have not been vetted by the process used to implement previous measures and that CMS might not be equipped to handle all of the new data (Reichard, CQ HealthBeat, 4/14).

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