Emily Kelley was taken to Emory Community Hospital for pain in her side. She was

Question

Emily Kelley was taken to Emory Community Hospital for pain in her side. She was admitted and taken into surgery, where her appendix was removed. In recovery her temperature spiked, and after looking at Emily’s labs it was determined she had developed an infection from the surgery. This was not the first surgery where an infection subsequently developed, and the current total HAC score for this hospital was 8. As a result of the high HAC score, the reimbursement to the hospital for Emily’s surgery was less than it should have been based on APC grouping. The billers started noticing a decrease in reimbursement, and brought it up to the manager.

Why would the reimbursement rate decrease for this hospital?

What should the hospital do to determine why the infection rates are high?

What can patients do if they have choices of where to go for their care?

Explanation / Answer

In the year 2017, the Federal Government has cut 796 Hospitals Medicare payments due to higher rates of hospital Acquired condition. As a result, the hospital lost $430 million of Medicare payment cuts. The HAC score is calculated based on the performance of hospitals on six quality measures that include:

Hospitals with total HAC score of more than 75th percentile will lead to Medicare payment cut.

The patient protection and Affordable Care Act(ACA) establishes the HAC reduction program in order to give incentive for hospitals to reduce HAC. Reduction Program reduces Medicare payment by 1%. Calculation of Total HAC associated with the domain. Domain 1 associated with patient safety indicator, and Domain 2 associated with Standardized infection Ratios.In addition to this, the hospital can also use the AHRQ developed tool to determine the highest rates of HAC.

CMS has to find difficulties whether the infection occurred during the hospital stay. Additional payments will not be given. HAc is not considered as the patient individualized risk. No medicare discharge assigned to severity under HAC-POC. MS-DRG based on preventable complication during the hospital stay. General public also crucially important in reducton of HAC. Hospital also penalized for the patients who readmitted within 30 days of discharge. The only choices of patients are to get proper care, instructions, and advice before discharges to protect themselves from HAC.

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