The initial financial impact of Medicare's new Value-based Purchasing initiative will be relatively small for U.S. hospitals in regard to hospital-acquired conditions, according to new research.
A low incidence of hospital-acquired conditions, or HACs, for five of the most common cardiovascular procedures will minimize the financial impact on hospitals of the Medicare Value-based Purchase Program. Hospitals will lose an average $10,000 to $20,000 per case on such procedures, according to Harvard researcher Matthew Reynolds, MD.
Reynolds, of the Harvard Clinical Research Institute, presented the findings this week at the American Heart Association's Scientific Sessions 2008 in New Orleans.
Reynolds said the new Medicare initiative - which took effect on October 1, 2008 - would have a minimal effect for most of the 11 HACs for which higher reimbursement rates will no longer be assigned.
However, losses might be higher for two of the HACs when associated with cardiac surgical procedures: mediastinitis (a chest infection) at nearly $70,000, and pressure ulcers at more than $40,000.
The good news was the low incidence rates, just a tenth of a percent, for six of the 11 HACs, and less than 1 percent for four others. One exception was "falls for pacemaker implant patients," which exceeded 2 percent during fiscal year 2006.
The research, funded and conducted by Cardiac Data Solutions, studied data on Medicare beneficiaries who underwent one of the following procedures between October 1, 2005 and September 30, 2006:
- isolated coronary artery bypass surgery
- any cardiac valve surgery
- percutaneous coronary intervention
- an implantable cardioverter defibrillator implant
- a permanent pacemaker implant
"The study results were generally good news for U.S. hospitals, with both the HAC incidence rates and expected incremental costs relatively low in most cases," said April Simon, president of Cardiac Data Solutions. "The exception could be hospitals with disproportionate rates of HACs no longer being covered at a higher rate by CMS."
Simon said the study also suggests that hospitals should pay particular attention to incidence rates for pressure ulcers, falls, and mediastinitis associated with cardiovascular procedures and focus efforts to improve quality in these areas.