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									  Patient Safety in Medicaid:
Never Events/Hospital Acquired
  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

• 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

 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

 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
     Provide Technical Assistance
     Reduce health disparities
     Promote innovation and the evidence base for
      effective use of technology
     Value Based Purchasing: QI – P4R – P4P
              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:

• 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.

              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:

           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

   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

        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?
                             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

Medicaid Patient Safety Webpage

The Right Care for Every
  Person Every Time

    John Young (410)786-0505
   Gary Jackson (410) 786-1218


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