New regulations, seismic impact

On October 1, 2008, the Centers for Medicare and Medicaid Services (CMS) launched a new and restrictive payment policy for certain hospital-acquired conditions (HACs). Medicare will no longer pay hospitals for the increased costs of care that result when one of these conditions harms a patient unless documented upon admission. CMS has identified ten conditions or events determined to be reasonably preventable. These conditions stem from the National Quality Forums Serious Reportable Events list of identifiable, preventable, and serious events that can occur in hospitals (called never events). They are: 1. Foreign objects retained after surgery 2. Death/disability associated with intravascular air embolism 3. Catheter-associated urinary tract infections 4. Death/disability associated with incompatible blood 5. Vascular catheter-associated infection 6. Stage 3 or 4 pressure ulcers 7. Hospital-acquired infections 8. Manifestations of poor glycemic control 9. Surgical-site infections following: a. Coronary artery bypass graft mediastinitis b. Bariatric surgery c. Certain orthopedic procedures 10. Deep vein thrombosis (DVT) or pulmonary embolism (PE) following: a. Total knee replacement b. Total hip replacement A list of additional non-covered conditions is expected to be unveiled for 2010. Commercial insurance companies are implementing similar changes in their reimbursement policies, thus expanding restrictions on reimbursement beyond Medicare beneficiaries.