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GAO Calls on HHS to Step Up Oversight of Hospital-Acquired Infections In a report released Wednesday, the Government Accountability Office (GAO) states that the federal government is not doing enough to prevent hospital-acquired infections (HAIs) and calls on the U.S. Department of Health and Human Services (HHS) to identify priorities among recommended prevention practices and "establish greater consistency and compatibility" in HAI reporting, CQ HealthBeat reports. While noting that the Centers for Disease Control and Prevention (CDC) has created 13 guidelines encompassing nearly 1,200 recommended practices for hospitals regarding infection control, the report says the guidelines fail to take into account factors such as the costs and organizational obstacles associated with implementation. The GAO identified similar problems with the infection control standards required by the Centers for Medicare and Medicaid Services (CMS) and other hospital accrediting agencies, suggesting that, while these standards describe "fundamental components of a hospital's infection control program," they "generally do not require that hospitals implement all recommended practices in CDC's guidelines." In evaluating HHS's efforts to collect data on HAIs, meanwhile, the GAO notes that, although multiple HHS agencies currently collect HAI-related data, the quality of the information is limited because each agency focuses on different types of HAIs and different sets of patients, providing an incomplete picture of the scope of the HAI problem. In addition, poor integration across databases limits the data's utility. Noting that the various efforts to address HAIs have not yet gained sufficient traction, the GAO highlights two main factors limiting the initiatives' efficacy, including the lack of department-level prioritization within the CDC and HHS's failure to effectively use the HAI data it collects. To correct these shortcomings, the report calls on the HHS secretary to "influence hospitals to take more aggressive action to control or prevent HAIs" by issuing more specific guidelines, requiring hospitals to comply with certain standards, releasing data to expand information about the nature of the problem and adjusting hospital payment systems to encourage the elimination of HAIs. In addition, the report calls for greater consistency and compatibility among data collected by HHS on HAIs. CQ HealthBeat notes that HHS largely agreed with the findings, with the department's deputy assistant secretary saying that the agency would "make every effort to move forward with the recommendations as proposed by the GAO." Press Release - 04/25/2008 CMS Proposal for 2009 acute care inpatient hospital proposed rule CMS estimates that the policies proposed will result in an increase in aggregate IPPS payments of nearly $4 billion over estimated payments for FY 2008. The proposed changes would be effective October 1, 2008. CMS is seeking public comments on its proposals for 60 days. Comments must be submitted no later than June 13, 2008. Below is an outline of key elements of the FY 2009 IPPS proposed rule. 1. Update to Standardized Amount. o CMS proposes a standardized amount of $5,098.96 for FY 2009. o The proposed FY 2009 standardized amount is an increase of 2.7 percent over the standardized amount for FY 2008. 2. Update of the Outlier Threshold. o CMS proposes a fixed-loss amount of $21,025 for FY 2009. o This is a lower amount than the fixed-loss amount of $22,185 that CMS set for FY 2008 3. Completion of Transition to Cost-Based Weights and MS-DRGs. o CMS paid hospitals based on a blend of the new MS-DRGs and the old DRGs. CMS proposes to pay hospitals solely based on MS-DRGs in FY 2009. 4. Addition of New Measures Under the Reporting Hospital Quality Data for Annual Payment Update (RHQDAPU) Program. o CMS proposes to add 43 new quality measures and delete 1 measure for payments beginning in FY 2010. o This would bring the total number of measures to 72. o CMS would delete the existing Pneumonia Oxygenation Assessment measure and add the following categories of new measures: Ø Surgical Care Improvement Project measure; Ø nursing-sensitive measures; Ø readmission measures; Ø venous thromboembolism measures; Ø stroke measures; Ø Patient Safety Indicators and Inpatient Quality Indicators developed by the Agency for Healthcare Research and Quality; and Ø cardiac surgery measures derived from The Society of Thoracic Surgeons’ National Cardiac Database. 5. Payment Adjustment for Hospital-Acquired Conditions. o Beginning in FY 2009, CMS will no longer pay extra for cases that involve certain hospital-acquired secondary conditions that could reasonably have been prevented through the application of evidence-based guidelines. o In the FY 2008 IPPS final rule, CMS selected 8 conditions to be subject to this payment adjustment, although the payment adjustment was not to be implemented until FY 2009. The RAND and RTI reports can be found on the CMS website by clicking here o CMS now requests public comment on whether the following 9 conditions (in addition to the 8 conditions selected in the FY 2008 final rule) should be subject to the payment adjustment for hospital-acquired conditions: Ø Surgical-site infections following elective surgeries; Ø Legionnaires’ disease; Ø Glycemic control; Ø Iatrogenic pneumothorax; Ø Delirium; Ø Ventilator-associated pneumonia; Ø Deep vein thrombosis/pulmonary embolism; Ø Staphylococcus aureus septicemia; and Ø Clostridium difficile-associated disease. 6. Modification of the Hospital Wage Index System. o CMS, proposes two significant changes to the current wage index system. o CMS proposes to adjust for “rural floor” and “imputed rural floor” budget neutrality on a state-by-state basis. o CMS would make it more difficult for a hospital to reclassify to another geographic area for purposes of the hospital wage index adjustment. 7. New Technology Add-On Payment. o Under the IPPS, CMS selects certain new services and technologies for an IPPS add-on payment. o CMS requests comment on the following four applications: Ø Cardio-West™ Temporary Total Artificial Heart System; Ø Emphasys Medical Zephyr® Endobronchial Valve; Ø Oxiplex® viscoelastic gel; and Ø TherOx Downstream® SuperSaturatedOxygen Therapy System. 8. Postacute Care Transfer Payment Policy. o CMS would expand its postacute care transfer payment policy with respect to transfers to a home with a written plan for provision of home health services. o CMS proposes to change this 3-day threshold to a 7-day threshold. 9. Other IPPS Payment Policies. This proposed rule also addresses the following IPPS payment policies: o CMS proposes: Ø Modifying the hospital cost report to better capture the costs of implantable devices. CMS intends to use this information to calculate more accurate payment weights for MS-DRGs that involve these devices. Ø Making a number of changes to MS-DRG assignments. Ø Extending its “imputed rural floor” policy, which was due to expire at the end of FY 2009, through FY 2011. o CMS also discusses how best to approach the events on the National Quality Forum’s list of Serious Reportable Adverse Events (also known as “never events”). It notes that it is exploring a wide range of approaches, including payment adjustments, coverage policy, conditions of participation, and Quality Improvement Organization retrospective review. 10. Other Issues. CMS also proposes several policies and requests comments on other issues that are not directly related to payment under the IPPS. o CMS proposes to amend the physician self-referral (or “Stark”) provisions as follows: Ø Modify the Stark “stand in the shoes” provisions to accommodate certain financial transactions made between physicians and academic medical centers or integrated healthcare delivery systems and require a designated health service (DHS) entity to stand in the shoes of an organization in which it has a 100 percent ownership interest. Ø Revise the definitions of “physician” and “physician organization.” Ø Clarify the period of time for which a physician would be prohibited from referring Medicare patients to an entity for DHS and for which the DHS entity would be prohibited from billing for DHS if a financial relationship between the physician and the entity fails to meet a Stark exception. o CMS continues to expand its efforts to evaluate physician ownership of hospitals. Ø CMS would Require a sample of 500 hospitals to submit a Disclosure of Financial Relationships Report to collect information about financial relationships between hospitals and physicians. Ø CMS would Expand an existing hospital condition of participation to require disclosure to patients of hospital ownership interests held by physicians and their relatives. Ø CMS also requests public comment regarding program integrity concerns with respect to hospital-physician gainsharing arrangements and physician-owned implant companies. o CMS proposes to collect from Medicare Advantage (MA) organizations encounter-level data for services provided to their enrollees. The agency states that these data could inform CMS’s MA risk-adjustment models. The complete CMS document for the proposed IPPS plans for FY 2009 are available by clicking here Press Release - 04/25/2008 RAND and RTI Reports on Refinements to the Inpatient Prospective Payment System (IPPS) Relative Weights In the FY 2009 IPPS Proposed Rule, issued on April 14, 2008, we stated that we had contracted with RAND to evaluate how the relative weights would change if we were to adopt regression-based cost to charge ratios (CCRs) to address charge compression while simultaneously adopting an HSRV methodology using fully phased-in Medicare Severity-Diagnosis Related Groups (MS-DRGs). Because RAND’s analysis was not complete in time for the IPPS proposed rule, we were not able to include a discussion of the report. However, we indicated that we would post the link to the RAND report on our website and we would welcome public comment on the report. Also in the FY2009 IPPS Proposed Rule, we stated that RTI had been contracted to further analyze charge compression including a reassessment of the regression-based CCR models using both outpatient and inpatient charge data. However, during the development of the IPPS proposed rule, RTI’s findings were not available. The IPPS-related chapters of this report are now available, and we have posted the link to the RTI report for public comment. The RAND and RTI reports can be found on the CMS website by clicking here Press Release - 04/04/2008 CMS Releases Regulation Modernizing Dialysis Centers The Centers for Medicare & Medicaid Services (CMS) today released a final rule that will modernize the Medicare conditions for coverage for the nation's dialysis centers and promote higher quality of care for patients receiving dialysis. Beneficiaries will benefit by the following updates in the rule: *Adopts updated Centers for Disease Prevention and Control (CDC) guidelines for hemodialysis facilities to increase patient infection control procedures. * Adopts updated American Association for Medical Instrumentation (AAMI) water quality guidelines to promote safer water for dialysis use. *Requires defibrillators in every dialysis facility, to allow facility staff to respond rapidly to individuals that may be having a heart attack. *Incorporates sections of the 2000 Life Safety Code, which upgrades fire safety standards. *Expands patient rights protection. The final rule is displayed by clicking here Press Release - 12/26/2007 CMS Released Version 5 of the FY 08 PPS PC Pricer on 12/21/07 Under the Medicare inpatient prospective payment system (PPS) using – the new “MS DRGs”, an acute care hospital is paid a fixed amount for each patient discharged in a particular treatment category known as a Diagnosis Related Group (DRG). The FY 08 DRG system is composed of 745 risk adjusted MS DRGs. This fixed payment amount is intended to cover the cost of treating a typical patient for a particular MS DRG at a specific hospital. The PPS Pricer software is released routinely on a quarterly basis, although this year there has been a series of Pricer releases to be used for Q1 2008. Version 5 supersedes all prior versions released this year for FY 08. The current Version 5 calculates Medicare payment amounts for patients discharged between October 1 and December 31, 2007 The Pricer Prospective Payment System (PPS) is used for pricing information needed by providers who wish to do any of the following: Predict payment for services they plan to provide, or Calculate the payment they will receive for a particular claim (in order to accurately post accounts receivable), or Validate that they have received correct payment for a claim upon receipt of their Medicare remittance advice. The PPS PC Pricer version 5 is available for download click here. Note SMA Informatics has available a national data file composed of FY 08 Medicare Expected Payments by Provider by MS DRG, calculated using the V5 PPS PC Pricer. Press Release - 12/26/07 SMA Informatics Announces Availability of FY 08 National Data Files Displaying Expected Medicare Payments for All IPPS Hospitals and Ambulatory Surgery Centers (ASC) SMA Informatics announces the immediate availability of two new national data reference files displaying the calculated Expected Medicare Payment by Facility FY 08 Q1 ( Oct-Dec 2007). The new files contain the Expected Medicare Payment by facility by payment code • Each IPPS Hospital by MS- DRG, Pricer version 5 • Each participating ASC by HCPCS To purchase defined extracts from either national data file at the level of a cluster of peer providers, self selected regional provider set or complete index of all facilities in a state contact: SMA08_Data@smainformatics.com or Call 804.344.8111
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