Patient Safety in Medicaid: Never Events/Hospital Acquired Conditions

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Patient Safety in MedicaidNever Events/Hospital
Acquired Conditions

• John M. Young, MPH, MA, Acting Director
• Division of Quality, Evaluation, and Health
  Outcomes
• Center for Medicaid and State Operations
• Centers for Medicare Medicaid Services

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• Secretary Leavitt challenged State Medicaid
  programs to partner in a value driven health-care
  initiative based on four cornerstones
• Intraoperable health information technology
• Measuring and publishing quality information
• Measuring and publishing price information
• Creating positive incentives for high quality
  health care purchasers

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Medicaid/SCHIP Quality Strategy

• CMS Quality Roadmap
• Vision The right care for every person every
  time
• Aims Make care safe, effective, efficient,
  person-centered, timely and equitable

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• Pillars of Medicaid Strategy
• National Medicaid Quality Framework
• State Quality Assessment Reports (QAR)
• Identify Promising Practices
• Work through partnerships
• Measure quality by reporting on an aligned set of
  measures
• Provide Technical Assistance
• Reduce health disparities
• Promote innovation and the evidence base for
  effective use of technology
• Value Based Purchasing QI P4R P4P

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The HAC Problem

• In 2000, CDC estimated that hospital-acquired
  infections add nearly 5 billion to U.S. health
  care costs annually
• Centers for Disease Control and Prevention
  Press Release, March 2000. Available at
  http//www.cdc.gov/od/oc/media/pressrel/r2k0306b.h
  tm.
• A 2007 study found that, in 2002, 1.7 million
  hospital-acquired infections were associated with
  99,000 deaths
• Klevens et al. Estimating Health
  Care-Associated Infections and
• Deaths in U.S. Hospitals, 2002. Public Health
  Reports. March-April
• 2007. Volume 122.

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The HAC Problem

• A 2007 Leapfrog Group survey of 1,256 hospitals
  found that 87 of those hospitals do not
  consistently follow recommendations to prevent
  many of the most common hospital-acquired
  infections
• 2007 Leapfrog Group Hospital Survey. The
  Leapfrog Group 2007.
• Available at http//www.leapfroggroup.org/media
  /file/Leapfrog_hospital_acquired_
• infections_release.pdf

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Statutory Authority DRA Section 5001(c)

• Beginning October 1, 2007, IPPS hospitals were
  required to submit data on their claims for
  payment indicating whether diagnoses were present
  on admission (POA)
• Beginning October 1, 2008, CMS cannot assign a
  case to a higher DRG based on the occurrence of
  one of the selected conditions, if that condition
  was acquired during the hospitalization

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Statutory Selection Criteria

• CMS must select conditions that are
• High cost, high volume, or both
• Assigned to a higher paying DRG when present as a
  secondary diagnosis
• Reasonably preventable through the application of
  evidence-based guidelines

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Medicaid Response

• Issued July 31st SMD
• Encourages States to adopt nonpayment policies to
  coordinate with Medicare Rule
• There is no blanket Medicaid policy
• Lists HAC/Never Events
• Guidance related to implementation Strategies to
  Prevent Healthcare-Associated Infections in Acute
  Care Hospitals
• How do keep list current?

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Current Status
State SPA Status / 90th Day Never Events Methodology State Reported Financial Impact from 179
State 1 08-0xx 12/21/2008 Revises plan to clarify approved rates not applicable for HAC identified as non-payable by Medicare. FFY 2009 0 FFY 2010 0
State 2 08-0xx 12/24/2008 Revised plan to eliminate payment for claims where Medicare has refused payment based on "Never Events" policy. This provision is only effective for those claims where Medicaid would be the secondary payer. FFY 2009 0 FFY 2010 0
State 3 08-0xx 12/28/2008 Revises reimbursement to clarify that approved reimbursement rates are not applicable for HAC non-payable by Medicare. FFY 2009 0 FFY 2010 0
State 4 08-0xx 12/21/2008 Revises reimbursement to eliminate Medicaid payments for hospital-acquired conditions. State will use POA indicators on UB forms to isolate claims. FFP reflects 179, this should be a negative number, analyst to confirm with the State. FFY 2008 250,000 FFY 2009 1,000,000
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Medicaid Patient Safety Webpage
Websitehttp//www.cms.hhs.gov/MedicaidSCHIPQualPra
c/20_Patient_20Safety.aspTopOfPage
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• The Right Care for Every
• Person Every Time
• John Young [phone]
• Gary Jackson [phone]