CMS proposes stricter rules for hospital errors to save $50M yearly

CMS is trying to cut back payment for hospital errors to save money. Source: The National Medicare Congress

The Centers for Medicare & Medicaid Services (CMS) has proposed a rule that would expand on the number of "never events," or preventable errors, a patient incurs in a hospital, and for which the agency said it will no longer pay the hospitals.

If accepted, the proposed ruling will expand the list of conditions which are preventable through proper care and for which Medicare said it will no longer pay if the patient acquires them during a hospital stay. CMS has also added 43 new quality measures for which hospitals will have to report data, in order to receive the full annual payment update for their services.

The government reported that the proposed rule will save Medicare an estimated $50 million annually over the next three years, the Associated Press reported. 

Patient safety incidents cost the federal Medicare program $8.8 billion and resulted in 238,337 potentially preventable deaths during 2004 through 2006, according to HealthGrades' fifth annual Patient Safety in American Hospitals Study.

"CMS is taking aggressive actions to ensure that beneficiaries get safe, high quality and efficient care from their healthcare providers, and the actions we are announcing…build on our efforts," said CMS Acting Administrator Kerry Weems.

The proposed changes would be applicable to discharges from a hospital occurring on or after the fiscal year of 2009, which begins on Oct. 1, 2008.

The proposed rule expands two initiatives: the Hospital-Acquired Conditions (HAC) and the Hospital Quality Measure Reporting initiatives. Under the HAC initiative, beginning Oct. 1, Medicare will no longer pay hospitals at a higher rate for the increased costs of care that result when a patient is harmed by one of several preventable conditions they did not have when they were first admitted to the hospital.

On Oct. 1, 20007, the HAC provisions required hospitals to begin reporting on their Medicare claims, whether specified diagnoses were present when the patient was admitted.

The first eight conditions, which were selected last year because they greatly complicate the treatment of the illness or injury that caused the hospitalization, and resulted in higher payments to the hospital for the patient's care by both Medicare and the patient, were: object inadvertently left in after surgery; air embolism; blood incompatibility; catheter-associated urinary tract infection; pressure ulcer; vascular catheter-associated infection; surgical site infection, such as mediastinitis after coronary artery bypass graft surgery; and certain types of falls and trauma.

CMS is currently proposing to expand the list of conditions to include:

• Deep vein thrombosis/pulmonary embolism;
• Surgical site infections following certain elective procedures;
• Legionnaires' disease (a type of pneumonia caused by a specific bacterium);
• Extreme blood sugar derangement;
• Iatrogenic pneumothorax;
• Delirium;
• Ventilator-associated pneumonia;
• Staphylococcus aureus septicemia (bloodstream infection); and
• Clostridium difficile associated disease (a bacterium that causes severe diarrhea).

The second proposed initiative is the expansion of the hospital quality measure reporting program, which reduces the amount a hospital is paid if it does not participate in the voluntary reporting of standardized quality measures.

CMS is accepting comments until June 13.