From the March 2017 issue of HealthCare Business News magazine
CMS publishes the annual list of 769 hospitals in the lower HAC score quartile that experience a 1 percent cut in payment. Of that total, 241 hospitals have been on the list three consecutive years due to low scores. Drilling down on the numbers and focusing on the type of facilities on the CMS list indicate that some of the hospitals are most likely research-based or teaching hospitals. These hospitals, which tend to be located in urban areas, may be unfairly counted for two reasons.
They have very specialized cases and they treat cases that other hospitals send them. In addition to serving a more complicated patient base, research and teaching hospitals have more robust surveillance systems to identify infections that might be missed by other types of hospitals. The reductions not only apply to patient stays, but also reduce the amount of money hospitals receive to teach medical residents and provide care for low-income people. This translates to a higher penalty for hospitals that treat mostly uninsured and low-income patients.
Specialized hospitals, such as those that treat psychiatric patients, veterans and children, are exempted from the penalties, as are hospitals with the “critical access” designation for being the only provider in an area. Of the remaining hospitals, the ACA requires CMS to penalize the bottom-performing 25 percent, even if they have reduced infection rates from previous years.
In order to provide the highest quality care possible to patients, a hospital can improve its financial standing by incorporating a more robust infection prevention and control program into project management plans. This is a particularly important step when hospitals are undergoing construction and renovation projects to minimize the risk and prevent health care-associated infections.
The risk of HACs increases significantly during construction-related activities due to the potential of contaminated dust particles being widely dispersed and posing a health risk for patients. Exposure to these infection-laden organisms can be life-threatening or fatal for patients who are severely immune-suppressed. However, not all hospitals are operating to the best of their ability and require changes that include everyone from the EVS technician to the surgeon. Administrators must communicate the message and drive quality change at every level, not just at those identified by CMS.
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