No, Medicaid patients are also subject to certain payment reductions. Publicly-reportable data may be accessed through Hospital Compare within : Ī helpful fact sheet and an FAQ to better understand the HAC reduction program may be accessed by visiting the following link: Do these terms apply only to Medicare inpatient payments? Central Line-Associated Bloodstream Infection (CLABSI), Catheter-Associated Urinary Tract Infection (CAUTI), Surgical Site Infection (SSI), Methicillin-resistant Staphylococcus aureus (MRSA) bacteremia, and Clostridium difficile Infection (CDI) measure.Patient Safety Indicator (PSI) 90 Composite measure score (see FAQ 2).Of note, CMS reports on the following HAC Reduction Program scores as of FY 2019: The mean SIR decreased from 1.12 in FY 2015 and 1.17 in FY 2016 to 0.91 in FY 2017. In FY 2017, 769 of 3,203 hospitals ranked in the worst performing quartile and were subject to payment reduction, as compared to 751 hospitals out of 3,211 hospitals in FY 2016.Īcross FY 2015, FY 2016, and FY 2017, the average performance across eligible hospitals improved for the mean Catheter-Associated Urinary Tract Infection (CAUTI) standardized infection ratio (SIR). HAC reductions are applied after adjustments for the Value-Based Purchasing and the Readmission Reduction Programs. By statute, hospital payments are reduced by 1 percent for hospitals that rank among the lowest-performing 25 percent with regard to HACs. Based on these payment reforms, inpatient hospital stays with certain HAC are reimbursed as though the conditions were not present.īeginning in Fiscal Year (FY) 2015, a HAC Reduction Program began to impose financial penalties on hospitals that performed poorly with regard to certain HACs. Hospitals began mandatory reporting of POA codes for Medicare inpatient claims on October 1, 2007.Įffective October 1, 2008, CMS reformed payment of inpatient facility services for conditions not identified as POA. POA Indicator codes must be assigned to all inpatient principal and secondary diagnosis codes, and most external cause of injury codes (ICD-9-CM “E codes” and ICD-10-CM “W, X, Y codes”). HAC/POA data track the development of nosocomial infections and other adverse effects or iatrogenic complications during the inpatient hospital stay. They estimate that approximately 125,000 fewer patients died due to hospital-acquired conditions and more than $28 billion in health care costs were saved from 2010 through 2015. The analysis indicated that hospitalized patients experienced > 3 million fewer HACs over the 5-year span (2011–2015) than if the HAC rate had remained at the 2010 level (representing a 21% decline). CMS entitled the program “Hospital-Acquired Conditions and Present on Admission Indicator Reporting” and it views this initiative as an incentive for hospitals to improve patient care.Īs a back-drop to this initiative, CMS recently published annual HAC rates and estimates of cost savings and deaths averted from 2010 to 2015. In other words, hospitals would no longer receive additional payments for the care required as a result of certain accidents and medical errors that occurred during a hospital stay. The Deficit Reduction Act of 2005 mandated a quality adjustment in Medicare Diagnosis Related Group (DRG) payments for certain hospital-acquired conditions (HAC) when the condition was not present on admission (POA) to the hospital. OPPC: Other Provider Preventable Conditions
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