Centers for Medicare & Medicaid services payments

AORN Journal,  April, 2008  by Robin Chard

• E-mail
• Print
• Link

QUESTION: There has been much discussion about the decision by the Centers for Medicare & Medicaid Services (CMS) to deny payment to hospitals for patient conditions acquired from preventable errors. What are the conditions, and how will this affect perioperative nursing?

ANSWER: The hospital-acquired conditions that were determined by the CMS to result from preventable errors are

* falls and trauma injuries, which include burns, fractures, dislocations, and intra-cranial and crushing injuries;

* pressure ulcers;

* catheter-associated urinary tract and vascular infections; and

* mediastinitis from coronary artery bypass surgery. (1)

In addition, the CMS identified objects left in a patient after surgery, air embolism, and blood incompatibility reactions as three serious preventable events that should never occur. (1)

The CMS program "Hospital-Acquired Conditions (HAC) and Present on Admission (POA) Indicator Reporting" resulted from the Deficit Reduction Act signed by President George W. Bush in 2005. The act required the Secretary of the Department of Health and Human Services to identify at least two conditions

   that are (a) high cost or high volume or both, (b)
   result in the assignment of a case to a Diagnostic
   Related Group (DRG) that has a higher payment
   when present as a secondary diagnosis, and (c)
   could reasonably have been prevented through
   the application of evidence-based guidelines. (2)

If one of the preventable conditions is present on discharge on or after October 1, 2008, the hospital will not receive additional payments. The CMS provides detailed instructions relating to coding and reporting requirements, documentation, and claims filing as well as educational resources on its web site at http://www.cms.hhs.gov /HospitalAcqCond/O7_EducationalResources.asp. (3)

As a patient moves through the health care system, personnel from each department can and should do their part to prevent these conditions. Nurses have the authority and responsibility within their scope of practice to direct patient care through initiatives that reduce preventable complications. Because the CMS will pay for costs associated with conditions present on admission, the process begins with a thorough physical assessment and meticulous documentation. Some facilities are embedding standardized questions about preexisting conditions in the electronic health record? (4)

Although the law may appear punitive, these complications can have serious consequences for surgical patients; therefore, it is important for perioperative nurses to take the lead in preventing these conditions and the financial repercussions. The responsibility resides with the entire surgical team, especially in preventing retained foreign objects, which is one complication that the team "owns." Under the direction of the perioperative nurse, incorporating the best practices of AORN's "Recommended practices for sponge, sharp, and instrument counts" is an excellent way to begin. (5)

The list of complications is intimidating because a majority of the conditions occur as a direct result of surgery. A change in practice, no matter how small, that assists in reducing or eliminating these preventable conditions is a victory for patients and practitioners. As nurses move away from practice based on habit and tradition, evidence-based interventions will become the routine, resulting in improved patient outcomes.

REFERENCES

(1.) Hospital-acquired conditions. Centers for Medicare & Medicaid Services. http://www.cms.hhs.gov /HospitalAcqCond/06_Hospital-Acquired%20 Conditions.asp. Accessed February 8, 2008.

(2.) Overview. Centers for Medicare & Medicaid Services. http://www.cms.hhs.gov/HospitalAcq Cond/. Accessed February 8, 2008.

(3.) Educational resources. Centers for Medicare & Medicaid Services. http://www.cms.hhs.gov/Hos pitalAcqCond/07_EducationalResources.asp. Accessed Accessed February 8, 2008.

(4.) Keefe S. Ahead of the game. Adv Nurs. 2007; 8(26):27-30.

(5.) Recommended practices for sponge, sharp, and instrument counts. In: Perioperative Standards and Recommended Practices. Denver, CO: AORN, Inc; 2008:293-302.

ROBIN CHARD

RN, PHD, CNOR

PERIOPERATIVE NURSING SPECIALIST

AORN CENTER FOR NURSING PRACTICE

COPYRIGHT 2008 Association of Operating Room Nurses, Inc.
COPYRIGHT 2008 Gale, Cengage Learning