medicare: "hospital-acquired conditions" and "present on admission"
in december, the centers for medicare and medicaid (cms) held a public discussion seeking input on the new policies regarding "hospital-acquired conditions" and "present on admission." beginning october 2008, hospitals will receive lower medicare reimbursement if their inpatients suffer from "hospital-acquired conditions" which were not documented as "present on admission." the ana supports efforts to improve clinical quality and patient safety by reducing adverse events.
reporting healthcare associated infections: a state perspective
healthcare-associated infections (hais) are one of the top ten causes of death in the u.s., with estimates near 99,000 deaths each year. these infections are acquired by patients while receiving treatment for other conditions within a healthcare setting. the american hospital association's conducts an annual survey of hospitals and their characteristics. the 2002 survey revealed that of 1.7 million hospitalized patients, there were 155,668 deaths, of which 98,987 were caused by or associated with a hai, resulting in an estimated $4.5 billion in excess healthcare costs annually. prompted by the desire to improve patient outcomes and reduce costs -- along with an increased consumer demand for healthcare information -- a number of states have enacted legislation mandating that hospitals report cases of hais.
Sorry, I don't get your point... You're saying we should ignore the situation (MRSA, etc), hoping they'll be diagnosed somewhere else?
My point- not paying for care given to a patient as a solution to the rise of resistant organisms is political idiocy! The thinking is "infections are costing us too much- lets just not pay for treating them!!!" Hospitals are forced to expend resources and staff that already are strained to the limit to prove "we didn't give them this bug" so we can be paid for treating it. We get paid if the patient came in with it. Screening is great if you have the staff and resources, esp if it is for the benifit of the patients. Better staffing, education, monitoring for compliance, equipment changes,.... to solve the problem would be what I would prefer. The screening we are doing is to provide for billing/payment.
Specializes in Spinal Cord injuries, Emergency+EMS.
Many healthy people are positive for MRSA, but not infected. Are we going to have these people in full isolation? Will they all be getting Vanco? What will we be doing with this information other then documenting it?
skin or Upper resp tract carried?
skin carried- skin eradication regime doesn't need isolation unless they have a nasty dry skin condition - i forget what the active ingredient in the washing product is - but the regime is to wash with that instead of soap / shower gel / shampoo for five days including at least 2 hair washes...
upper resp tract - again elimination regime and isolation if required - bactrobon ointment is in outr eradication guideline
carriers of MRSA don't need Vanc - treating an infection that isn't there one of the great failures of US healthcare ( notice no one else in the world using topical antibiotics on none infected wounds and sticking plasters in europe are generally 'unmedicated')
My point- not paying for care given to a patient as a solution to the rise of resistant organisms is political idiocy! The thinking is "infections are costing us too much- lets just not pay for treating them!!!" Hospitals are forced to expend resources and staff that already are strained to the limit to prove "we didn't give them this bug" so we can be paid for treating it. We get paid if the patient came in with it. Screening is great if you have the staff and resources, esp if it is for the benifit of the patients. Better staffing, education, monitoring for compliance, equipment changes,.... to solve the problem would be what I would prefer. The screening we are doing is to provide for billing/payment.
Are you saying a payer will not pay for a HAI if the patient is in the contact facility. Sorry, I still don't understand. I am reading that a facility will get paid if the infection is pre-acquired, but not if it was aquired in-house? That can't be true..... I am in favor of testing for MRSA at any point available. It can remain dormant for years, but if you do have an active, undiagnosed case, it could infect every patient on the floor. Testing is good for the facility in terms of future liability, good for the other patients, and most importantly, good for the patient being tested. How can we argue the benefits vs the 5 minutes it takes to swab someone's cheek?
Many healthy people are positive for MRSA, but not infected. Are we going to have these people in full isolation? Will they all be getting Vanco? What will we be doing with this information other then documenting it?
Many people are carriers of something - HepC or the Sickle Cell Trait. It's a piece of health information that the patient, and providers, should have. Carriers of MRSA should be informed to monitor themselves for potential complications. Carriers certainly should not be treated, that's what created this mess in the first place. I am happy to say that most docs are beginning to follow advice the CDC posted several years ago, and not treating every little bug that comes down the pike with antibiotics. Strepp is a good example - when I worked in ambulatory care, my docs would do a strepp culture on every sore throat that presented (usually at the insistance of the patient), then treat with abx prophy while waiting for the results (Rapid-Strepp is not always reliable). 95% of those tests would come back negative, meaning all those folks took abx needlessly. I'm amazed there are not more super-infections out there.
No Medicare patient will be responsible for getting an infection, what CMS is saying the hospital has to eat the cost. Before this change you could up code the DRG payment if the patient acquired a UTI or decubitus. Now hospitals will not get the extra money if the patient has a hospital acquired infection. The patient can not be billed the difference and if they are the hospital could be faced with penalties and fines.
Second the only documentation CMS counts is MD, PA, or NP documentation.RNs and LPNs can chart a million times and it doesn't count.
The fiscal changes take effect October 2008, right now the new codes apply but you can charge the old rates. If you want any more admission, contact your local QIO ( the CMS rep in your area) and they can answer your questions.
How this is going to effect your job? It will effect the organizations bottom line.
No Medicare patient will be responsible for getting an infection, what CMS is saying the hospital has to eat the cost. Before this change you could up code the DRG payment if the patient acquired a UTI or decubitus. Now hospitals will not get the extra money if the patient has a hospital acquired infection. The patient can not be billed the difference and if they are the hospital could be faced with penalties and fines.
This sounds like a push for admissions testing. How in the world is CMS going to determine how a patient aquired MRSA during a 3-day stay, or an outpatient procedure? Doesn't sound realistic. We will need a whole new division to CMS - the MRSA Police. I think it would be more realistic to investigate and sanction facilities that can be linked to nosocmical infections. You can believe that nurses notes would be a primary focus of such an investigation. But as far as not paying, this would not be applicable to the majority of facility - aquired infections because of the nature of MRSA.
carriers of MRSA don't need Vanc - treating an infection that isn't there one of the great failures of US healthcare ( notice no one else in the world using topical antibiotics on none infected wounds and sticking plasters in europe are generally 'unmedicated')
Amen to that...Ours is the only system I know where a doc would dispense antibiotics to treat the common cold just to shut the parent up. We need to develop some backbone with people who "saw it on the internet."
Specializes in Med/Surg, Oncology, Hospice, Documentati.
Here is how the whole reporting of hospital-acquired conditions began: the hospital billing form was changed to include fields for present-on-admission indicators for EVERY SINGLE coded diagnosis for EVERY patient, whether they're Medicare, Blue Cross, whoever. The indicator choices are "Y-yes", "N--no", "U-unable to determine" or "W-not enough information to determine".
Beginning 10/1/07 this information has been going out to everyone: Medicare, commercial carriers, public aid, whoever. Once it is "out there" hospitals no longer have control over who sees it. Patient names may be protected, but the hospital-acquired condition (HAC) info isn't.
Many websites (HealthGrades, LeapFrog, Hospitalcompare) are using this information to provide information to the public about hospital performand.
Who controls what gets reported? The physicians. Only physician documentation is allowable for the reporting of ANY diagnoses. The information (positive urine cultures, etc) may be in the record but coders are not allowed to code from anything but physician documentation; this means the doctor must state the diagnosis in his dication, progress notes or orders first.
So: if the doc doesn't document the UTI/MRSA whatever until the 4th or 5th day of the stay the coder will code that diagnosis as "not present on admission".
Look at the situation another way: if you brought your car in to have the oil changed and drove away and your car failed due to the service station accidentally forgetting to replace the oil or, perhaps, draining your transmission fluid, wouldn't you expect the service station to pay for the repairs? Of course you would. Would you accept their excuse "well, it was an old car anyway". Of course not.
I review thousands of inpatient records every year with the specific goal of analyzing the physician documentation (and sometimes nursing documentation) to ensure that every condition that is treated, monitored or evaluated is documented. This is what constitutes a compliant record of the patient's care.
I've seen a disturbing trend of less and less documentation of what we're doing for our patients. There's less documentation that critical conditions were monitored, less documentation that sterile technique was used, and probably the biggest infection issue is that more and more is delegated to unlicensed personnel who have less than optimal infection-control techniques. Procedures that were previously done by nurses who used careful sterile technique are now delegated to aides who only have to have 6 week's training and from what I've seen, easily influenced by others' bad habits.
The fact is, we ARE causing these problems. But now everyone will know we are and this is forcing hospitals to take action and preventative measures. The result will be better patient care. People are being forced to be more careful, document more specifically and to be aware of the risk factors that cause these incidents. I don't see this as a bad thing. The maxim "if you didn't document it you didn't do it" is still true today.
Which of the nurses out there doesn't dread having to be a patient in a hospital today? I know that I do and if I was I'd want a nurse friend at my bedside 24 hours a day to make sure that I received the proper care.
Amen to that...Ours is the only system I know where a doc would dispense antibiotics to treat the common cold just to shut the parent up.."
Just FYI, in some countries you can buy antibiotics at a pharmacy without a prescription. Also, when I lived abroad in another country, many patients wouldn't feel that they got their money's worth for the appointment if the MD didn't give them some kind of medicine; the MDs, competing for patients, catered to that customer demand by dispensing antibiotics even when they probably wouldn't make a difference... so US isn't "the only system" that overuses antibiotics to satisfy "customer demands". It doesn't make it right, but it's not uncommon either.
january 30, 2008
suanna
1,549 Posts
My point- not paying for care given to a patient as a solution to the rise of resistant organisms is political idiocy! The thinking is "infections are costing us too much- lets just not pay for treating them!!!" Hospitals are forced to expend resources and staff that already are strained to the limit to prove "we didn't give them this bug" so we can be paid for treating it. We get paid if the patient came in with it. Screening is great if you have the staff and resources, esp if it is for the benifit of the patients. Better staffing, education, monitoring for compliance, equipment changes,.... to solve the problem would be what I would prefer. The screening we are doing is to provide for billing/payment.