Patient Complications Are on the Rise
Back in October 2014, CMS began implementing a 1% Medicare payment reduction for hospitals falling in the “worst-performing quartile with respect to hospital-acquired condition (HAC) quality measures,” as part of the HAC Reduction Program. This year, a resulting 764 hospitals will be subject to such a payment cut. Reductions are based on patient data acquired between mid-2018 and 2019, with 2020 being excluded due to COVID-19. This article will serve to explain what brought on these lackluster quality measures, as well as provide a solution towards preventing these complications moving forward.
A Financially Significant Problem
The Hospital-Acquired Conditions Reduction Program is a value-based purchasing program designed to increase hospital quality of care while reducing incidences of hospital-acquired conditions (and patient readmittance) through Medicare reimbursements. In their evaluation, CMS takes into consideration the prevalence of preventable patient complications, including rates of infection, blood clots, bedsores, falls, etc. This evaluation is then aggregated into a score and compared to a weighted national average. When a program’s hospital-acquired condition rates fall within the 75th percentile or higher, the program will be penalized with a reimbursement reduction of 1%. This may not seem as though it would have much impact, but when it is translated into a cost equivalent, it is significant. Consider an example program that may earn an inpatient annual revenue of $158,000,000. If 40% of that revenue is from Medicare reimbursement (40% = $63,200,000), then the program will realize a loss of $632,000. As mentioned previously, 764 hospitals will realize a 1% reduction in Medicare reimbursement in 2022.
Quality Improvement is a Necessity.
These are sobering considerations, but there are avenues to ensure that a program performs well within the required benchmarks and has the tools to reduce incidences of hospital readmissions for certain conditions. This is best achieved through a quality assurance/quality improvement process, such as Corazon Accreditation. Program accreditation will evaluate the overall performance of a program and elevate attention to those conditions leading to such a penalty. It will assess the existing quality processes to identify not only areas of opportunities for improvement but also successes. Additionally, the patient experience is also evaluated for the perceived quality of care through the review of patient flow processes. Finally, accreditation will analyze the outcome measures and compare program performance to national benchmarks and best practices.
Once the evaluation process is complete, the accrediting body will generate a process improvement report and present it to the program leadership. This report will identify the strengths and opportunities within the facility and bring to attention the resources needed to implement improvements. The purpose of accreditation, first and foremost, is to improve patient care and outcomes through quality improvement. If a program is accredited, it will have the necessary tools to ensure that the level of care exceeds industry standards and greatly reduce the incidences of hospital-acquired conditions.
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