Hospital Acquired Conditions Reduce Medicare Reimbursement on October 1,
2008

Are you confused about the difference between the National Quality
Forum's twenty-eight "never" events and the eight (or more) events for
which CMS will begin limiting reimbursement on October 1, 2008? I was.

Here's the scoop:

CMS Hospital Acquired Condition (HAC) initiative, begins October 1, 2008

Medicare will no longer pay the hospital at a higher rate for the
original eight conditions or any conditions added to the list in the
final rule, if they were acquired during the hospital stay.

These events, if hospital acquired, will qualify for decreased Medicare
reimbursement as of October 1, 2008:

1. Object inadvertently left in after surgery
2. Air embolism
3. Blood incompatibility
4. Catheter associated urinary tract infection
5. Pressure ulcer (decubitus ulcer)
6. Vascular catheter associated infection
7. Surgical site infection- Mediastinitis (infection in the chest)
after coronary artery bypass graft surgery
8. Certain types of falls and trauma

CMS is proposing to expand the list of conditions that need to be
reported if present when a patient is first admitted and is seeking
public comment on whether they should be added to the list in the final
rule to be announced later in 2008:

1. Surgical site infections following certain elective procedures
2. Legionnaires’ disease (a type of pneumonia caused by a specific
bacterium)
3. Extreme blood sugar derangement
4. Iatrogenic pneumothorax (collapse of the lung)
5. Delirium
6. Ventilator-associated pneumonia
7. Deep vein thrombosis/Pulmonary Embolism (formation/movement of a
blood clot)
8. Staphylococcus aureus septicemia (bloodstream infection)
9. Clostridium difficile associated disease (a bacterium that causes
severe diarrhea and more serious intestinal conditions such as colitis)

CMS Proposes to Expand Quality Program for Hospital Inpatient Services
in 2009

And here are the 28 "Never" Events from the National Quality Forum,which
contain some overlap with the CMS list, but are not the same.

1. Artificial insemination with the wrong donor sperm or donor egg
2. Unintended retention of a foreign object in a patient after
surgery or other procedure
3. Patient death or serious disability associated with patient
elopement (disappearance)
4. Patient death or serious disability associated with a medication
error (e.g., errors involving the wrong drug, wrong dose, wrong patient,
wrong time, wrong rate, wrong preparation or wrong route of administration)
5. Patient death or serious disability associated with a hemolytic
reaction due to the administration of ABO/HLA-incompatible blood or
blood products
6. Patient death or serious disability associated with an electric
shock or elective cardioversion while being cared for in a healthcare
facility
7. Patient death or serious disability associated with a fall while
being cared for in a healthcare facility
8. Surgery performed on the wrong body part
9. Surgery performed on the wrong patient
10. Wrong surgical procedure performed on a patient
11. Intraoperative or immediately post-operative death in an ASA
Class I patient
12. Patient death or serious disability associated with the use of
contaminated drugs, devices, or biologics provided by the healthcare
facility
13. Patient death or serious disability associated with the use or
function of a device in patient care, in which the device is used or
functions other than as intended
14. Patient death or serious disability associated with intravascular
air embolism that occurs while being cared for in a healthcare facility
15. Infant discharged to the wrong person
16. Patient suicide, or attempted suicide resulting in serious
disability, while being cared for in a healthcare facility
17. Maternal death or serious disability associated with labor or
delivery in a low-risk pregnancy while being cared for in a health care
facility
18. Patient death or serious disability associated with hypoglycemia,
the onset of which occurs while the patient is being cared for in a
healthcare facility
19. Death or serious disability (kernicterus) associated with failure
to identify and treat hyperbilirubinemia in neonates
20. Stage 3 or 4 pressure ulcers acquired after admission to a
healthcare facility
21. Patient death or serious disability due to spinal manipulative
therapy
22. Any incident in which a line designated for oxygen or other gas
to be delivered to a patient contains the wrong gas or is contaminated
by toxic substances
23. Patient death or serious disability associated with a burn
incurred from any source while being cared for in a healthcare facility
24. Patient death or serious disability associated with the use of
restraints or bedrails while being cared for in a healthcare facility
25. Any instance of care ordered by or provided by someone
impersonating a physician, nurse, pharmacist, or other licensed
healthcare provider
26. Abduction of a patient of any age
27. Sexual assault on a patient within or on the grounds of the
healthcare facility
28. Death or significant injury of a patient or staff member
resulting from a physical assault (i.e., battery) that occurs within or
on the grounds of the healthcare facility