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CMS adds three new conditions to no-pay list

Quality Improvement Monitor, August 8, 2008

CMS last week added three new hospital-acquired conditions (HAC) to its non-payment list and expanded the number of quality measures hospitals must report on to 42.

The new HACs include:

  • Surgical site infections following certain elective procedures, including certain orthopedic surgeries, and bariatric surgery for obesity
  • Certain manifestations of poor control of blood sugar levels
  • Deep vein thrombosis or pulmonary embolism following total knee replacement and hip replacement procedures

    Hospitals will not be reimbursed for those conditions beginning October 1, 2008, if they could have been reasonably prevented. The three are in addition to the eight HACs approved in 2007. Medicare will stop paying for those eight on October 1, 2008 as well.

    The federal agency, which had originally proposed adding 43 new quality reporting measures, scaled that back to 13 in its final inpatient prospective payment system (IPPS) rule. Hospitals that don’t report on quality measures forfeit 2% of their Medicare reimbursement. CMS also decided to retire one pneumonia measure – oxygenation assessment – effective January 1, 2009, bringing the total number of measures to 42. (For more on CMS’ IPPS rule, read the September issue of the Quality Improvement Report).

    For more information, click here.

     

     

     

     

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