Medicare changes mean hospitals on call to be more cautious - East Valley Tribune: Business

Medicare changes mean hospitals on call to be more cautious

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Posted: Friday, April 4, 2008 4:38 pm | Updated: 11:22 pm, Fri Oct 7, 2011.

Hospitals this fall will have more incentive than ever before to ensure patients don’t suffer preventable conditions such as serious bedsores and surgical site infections while in their care.

The Centers for Medicare & Medicaid Services, while updating its annual hospital payment system, identified eight hospital-acquired, preventable conditions that it will no longer pay for as of Oct. 1. The move is expected to save Medicare $20 million in the first year.

“We expect that it would improve the quality of care,” said Ellen Griffith, public affairs specialist with the Centers for Medicare & Medicaid Services, the federal agency that administers Medicare, Medicaid and the State Children’s Health Insurance Program. “We expect that you will find that hospitals will be making sure that people follow the kind of evidence-based guidelines that would prevent these kinds of occurrences.”

Local hospital systems applaud the measure, saying anything that helps ensure patient safety is a positive step.

Currently, if a Medicare patient is diagnosed with a particular condition upon admission and then is diagnosed with an additional condition — such as a broken hip — while in the hospital, Medicare would reimburse the hospital at a higher rate to cover both diagnoses, she said.

“Beginning Oct. 1, we will pay you for the primary diagnosis only and not for the higher payment rate that is the primary diagnosis plus the secondary diagnosis,” Griffith said. “It’s only really going to hurt hospitals if in fact it occurs frequently because then it’s likely the hospital is not following the guidelines for prevention.”

If a Medicare patient is diagnosed upon admission with one of these eight conditions along with their primary diagnosis, Medicare will continue paying the higher rate for multiple diagnoses, she said.

Hospitals cannot bill patients for any costs no longer covered by Medicare, Griffith said.

“It’s called fraud,” she said. “The payment rate is considered payment in full for the hospital stay, so that is all the hospital is entitled to collect. If the hospital were to go after the patient, that would be illegal.”

Patients can protect themselves by making sure the hospital isn’t billing them separately for anything that is included in the Medicare payment, Griffith said.

Other preventable conditions may be added to the list in coming years, including ventilator-associated pneumonia and deep vein thrombosis, or a blood clot that forms inside a vein deep inside the body.

“It’s pretty basic stuff,” Griffith said. “It’s the stuff that people see in the ER, put on your gown, put on your gloves, make sure that you keep sterile conditions, etc.”

Local hospital systems say they already have made reducing preventable conditions a priority.

“We have been putting systems in place to better be able to monitor this internally for the last year or so ... and since fall of 2007, we have been reviewing every single case,” said Cheralyn Beaudry, Scottsdale Healthcare’s associate vice president of quality and patient safety. “Essentially, what we do is we monitor every case for these eight conditions when patients are admitted, and then we also look to see when those patients are discharged whether they’ve actually acquired those conditions during the hospitalization. The numbers are very small at Scottsdale Healthcare, and we’re very proud of that.”

Bill Byron, Banner Health’s assistant director of public relations, said numerous initiatives are in place to ensure quality care, including more electronic monitoring and even “safety huddles” in the hospitals.

“We have a tremendous number of initiatives under way to address and decrease medical errors,” he said. “There are numerous ways that all of us can get engaged in patient safety. We flat-out agree with Medicare.”

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