Patient Safety in Medicaid: Never Events/Hospital Acquired Conditions John M. Young, MPH, MA, Acting Director Division of Quality, Evaluation, and Health Outcomes Center for Medicaid and State Operations Centers for Medicare & Medicaid Services 1 • Secretary Leavitt challenged State Medicaid programs to partner in a value driven health- care initiative based on four cornerstones: – Intraoperable health information technology – Measuring and publishing quality information – Measuring and publishing price information – Creating positive incentives for high quality health care purchasers 2 Medicaid/SCHIP Quality Strategy CMS Quality Roadmap • Vision: The right care for every person every time • Aims: Make care safe, effective, efficient, person- centered, timely; and equitable 3 Pillars of Medicaid Strategy National Medicaid Quality Framework State Quality Assessment Reports (QAR) Identify Promising Practices Work through partnerships Measure quality by reporting on an aligned set of measures Provide Technical Assistance Reduce health disparities Promote innovation and the evidence base for effective use of technology Value Based Purchasing: QI – P4R – P4P 4 The HAC Problem • In 2000, CDC estimated that hospital- acquired infections add nearly $5 billion to U.S. health care costs annually Centers for Disease Control and Prevention: Press Release, March 2000. Available at: http://www.cdc.gov/od/oc/media/pressrel/r2k0306b.htm. • A 2007 study found that, in 2002, 1.7 million hospital-acquired infections were associated with 99,000 deaths Klevens et al. Estimating Health Care-Associated Infections and Deaths in U.S. Hospitals, 2002. Public Health Reports. March-April 2007. Volume 122. 5 The HAC Problem • A 2007 Leapfrog Group survey of 1,256 hospitals found that 87% of those hospitals do not consistently follow recommendations to prevent many of the most common hospital-acquired infections 2007 Leapfrog Group Hospital Survey. The Leapfrog Group 2007. Available at: http://www.leapfroggroup.org/media/file/Leapfrog_hospital_acquired_ infections_release.pdf 6 Statutory Authority: DRA Section 5001(c) Beginning October 1, 2007, IPPS hospitals were required to submit data on their claims for payment indicating whether diagnoses were present on admission (POA) Beginning October 1, 2008, CMS cannot assign a case to a higher DRG based on the occurrence of one of the selected conditions, if that condition was acquired during the hospitalization 7 Statutory Selection Criteria CMS must select conditions that are: 1.High cost, high volume, or both 2.Assigned to a higher paying DRG when present as a secondary diagnosis 3.Reasonably preventable through the application of evidence-based guidelines 8 Medicaid Response • Issued July 31st SMD – Encourages States to adopt nonpayment policies to coordinate with Medicare Rule – There is no “blanket” Medicaid policy – Lists HAC/Never Events – Guidance related to implementation “Strategies to Prevent Healthcare-Associated Infections in Acute Care Hospitals” – How do keep list current? 9 Current Status State Reported Financial State SPA Status / 90th Day Never Events Methodology Impact from 179 Revises plan to clarify approved rates not applicable for FFY 2009 = $0 State #1 08-0xx 12/21/2008 HAC identified as non-payable by Medicare. FFY 2010 = $0 Revised plan to eliminate payment for claims where Medicare has refused payment based on "Never Events" policy. This provision is only effective for those claims where Medicaid would be the secondary FFY 2009 = $0 State #2 08-0xx 12/24/2008 payer. FFY 2010 = $0 Revises reimbursement to clarify that approved reimbursement rates are not applicable for HAC non- FFY 2009 = $0 State #3 08-0xx 12/28/2008 payable by Medicare. FFY 2010 = $0 Revises reimbursement to eliminate Medicaid payments for hospital-acquired conditions. State will use POA indicators on UB forms to isolate claims. FFP reflects 179, this should be a negative number, FFY 2008 = $ 250,000 State #4 08-0xx 12/21/2008 analyst to confirm with the State. FFY 2009 = $1,000,000 10 Medicaid Patient Safety Webpage Websitehttp://www.cms.hhs.gov/MedicaidSCHIPQualPrac/20_Patient_%20Safety.asp#TopOfPage 11 The Right Care for Every Person Every Time John Young (410)786-0505 Gary Jackson (410) 786-1218 12
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