The pressure will rise for hospitals to provide high-quality care and reduce mistakes, as Medicare seeks to tie reimbursement to quality.
The Centers for Medicare & Medicaid Services is announcing plans to expand the list of preventable conditions for which Medicare won't pay if a beneficiary experiences them as a result of a hospital stay.
In addition, the CMS announcement includes 43 new quality measures for which hospitals will have to report data to receive the full annual payment update for their services.
The proposed rule would apply to services provided to patients who are discharged from hospitals during the government's fiscal 2009 year, which begins Oct. 1, 2008. It also includes proposals to update Medicare payment rates and policies for inpatient hospitals for fiscal year 2009.
In the rule, CMS announced a mandated market-basket update of 3 percent for hospitals that report data; hospitals not providing quality information would get an update of only 1 percent.
An American Hospital Association review of the proposed rule took issue with the fact that many of the proposed quality measure had not been endorsed by the National Quality Forum or adopted by the Hospital Quality Alliance.
An AHA spokesperson said the organization also is concerned about transfer policies and capital payment update provisions in the proposed rule.
CMS will accept comments on the proposed rule until June 13, and the final rule will be released by August 1.
"CMS is taking aggressive actions to ensure that beneficiaries get safe, high-quality and efficient care from their healthcare providers," said Kerry Weems, CMS' acting administrator. "The status of the Medicare Hospital Insurance Trust Fund requires us to find the best solutions to ensure that Medicare stays strong while paying providers appropriately for the care they deliver."
The rule expands two initiatives previously enacted by CMS - the Hospital-Acquired Conditions and the Hospital Quality Measure Reporting initiatives. Under the former, Medicare no longer pays hospitals at a higher rate for the increased costs that result when a patient suffers one of eight preventable issues from a hospital stay.
CMS wants to add nine other conditions for which it won't pay: surgical site infections after certain elective procedures, Legionnaires' disease, extreme blood sugar derangement, collapse of a lung, delirium, ventilator-associated pneumonia, deep vein thrombosis, a certain type of blood stream infection and a bacteria-related disease that causes severe diarrhea.
The CMS proposal to add 43 quality measures would bring to 73 the total of standard measures on which hospitals would be required to submit data to receive a full update.