Health Information Management

Medicare’s HAC policy may not save much money

HIM-HIPAA Insider, September 15, 2009

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A new study shows Medicare’s policy against paying for hospital-acquired conditions will only save the $400 billion program $1.1 million to $2.7 million.

California researchers conducted the study, according to a Wall Street Journal article. The researchers studied discharge data from California Medicare beneficiaries in 2006, looking for six conditions the authors deemed definable, according to the article. Out of the total 767,995 cases, there were 828 cases of those conditions, and 26 would have been subject to lower payments.

Although CMS officials acknowledged that projected savings are not large, they suggested the study may be “limited and speculative.” They also said the penalties have been effective in changing behavior and improving hospital care.

According to the article, there are a couple of factors that make the policy less effective, including that Medicare has to rely on hospitals reporting their mistakes. Also, the circumstances for the policy are limited. For example, if a surgeon leaves a sponge in a patient, Medicare would not pay the hospital for the removal during that stay. But if the physician discovered the sponge in a separate visit, Medicare would pay.



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