CMS to Begin Implementing Payment Penalties Tied to Patient Outcomes

July 16, 2014
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CMS penaltiesA North Carolina academic hospital will be docked a percentage of Medicare reimbursements because of complications related to untoward patient outcomes. With respect to preventable (poor) outcomes, iatrogenic infections remain the area in which most preventive and systemic modalities can be put into place to increase performance metrics.

CMS penaltiesA North Carolina academic hospital will be docked a percentage of Medicare reimbursements because of complications related to untoward patient outcomes. With respect to preventable (poor) outcomes, iatrogenic infections remain the area in which most preventive and systemic modalities can be put into place to increase performance metrics. Sounds easy for an acute hospital to plan for such avoidable issues, right? Think again.

A quarter of the nation’s hospitals — those with the worst rates — will lose 1 percent of every Medicare payment for a year starting in October. In April, federal officials released a preliminary analysis of which hospitals would be assessed, identifying 761.

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Even infections that are waning are not decreasing fast enough to meet targets set by the government. Meanwhile new strains of antibiotic-resistant bacteria are making infections much harder to cure.

Currently, approximately 13 percent of hospital admissions — according to the feds — ultimately contract an iatrogenic infection. Although this is still a relatively “common” figure that easily identifiable, the problem many teaching hospitals have with making inroads into this number has more to do with the population that is served — large publicly owned tertiary care institutions serving many impoverished patients with low health literacy — than with simply identifying the source of these infections. The bigger issue here is — what does this say about the institutions: are teaching hospitals now suddenly harming patients more than other institutions (with seemingly fewer resources on the surface), simply because the federal government says they are? Or, are these hospitals facing certain penalties year after year because they simply cannot avoid certain patient demographics?

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