One uses of Medicare claims data is to assess and monitor different quality issues including HACs (Hospital Acquired Conditions). These are events deemed as preventable and avoidable by the hospital including bed sores, infections from catheters, and other infections that are typically recognized as being avoidable. CMS has cracked down by cutting Medicare payments to the tune of $373 million to 721 hospitals that are deemed at having the worse rates of patient infections and injuries. These include hospitals that I was shocked to hear were included: Brigham and Womens, The Cleveland Clinic, and Geisinger.
In determining the HAC penalties, Medicare judged hospitals on three measures: the frequency of central-line bloodstream infections caused by tubes used to pump fluids or medicine into veins, infections from tubes placed in bladders to remove urine, and rates of eight kinds of serious complications that occurred in hospitals, including collapsed lungs, surgical cuts, tears and reopened wounds and broken hips. Medicare tallied that and gave each hospital a score on a 10-point scale. Those in the top quarter — with a total score above 7 — were penalized, states the article.
This puts more pressure on hospitals to not only ensure their employees are following universally accepted infection control protocol such as frequent hand washing and computerized physician orders instead of being hand-written (and therefore subject to interpretation errors) but to also ensure clinical documentation and thereby claims billing accurately reflects the patient’s medical condition severity. One way to do this? You guessed it—-implement ICD-10.