INCORPORATING SELECTED NATIONAL QUALITY FORUM AND NEVER EVENTS INTO MEDICARES LIST OF HOSPITAL-ACQUIRED CONDITIONS

OVERVIEW:

On April 14, 2008, the Centers for Medicare & Medicaid Services (CMS) announced a proposed rule that would update payment policies and rates under the hospital inpatient prospective payment system (IPPS) for fiscal year (FY) 2009, beginning for discharges on or after October 1, 2008.  The proposed rule includes a discussion of candidates for addition to the list of hospital-acquired conditions (HACs) for FY 2009, including several conditions that have been identified by the National Quality Forum (NQF) as Serious Reportable Adverse Events (also called “Never Events”).  This Fact Sheet discusses only the relationship between the conditions that are subject to the HAC payment provisions in the IPPS proposed rule and those on the NQF Never Event list.  The complete list of existing and proposed conditions affected by the HAC payment provision can be found at http://www.cms.gov/About-CMS/Public-Affairs/MediaReleaseDatabase/Fact-Sheets/index.html

In addition, CMS is issuing a Fact Sheet discussing 43 new measures that are being proposed for the hospital quality measure reporting program in FY 2009, and that, if adopted, will be taken into account in determining whether the hospital will get the full FY 2010 update.

BACKGROUND:

Section 5001(c) of the Deficit Reduction Act (DRA) of 2005 required the Secretary of the Department of Health and Human Services to select at least two conditions that are: (1) high cost, high volume, or both; (2) identified through ICD-9-CM coding as a complicating condition (CC) or major complicating condition (MCC) that, when present as a secondary diagnosis at discharge, results in payment at a higher MS-DRG; and (3) reasonably preventable through application of evidence-based guidelines.  The law further required hospitals to begin reporting on claims for discharges, beginning October 1, 2007, whether the selected conditions were present on admission (POA). 

Last year, CMS selected eight conditions for the HAC provision.  These included seven of the 27 (now 28) conditions identified by the NQF as Never Events, with the falls, burns, and electric shock Never Events being treated as one HAC.  This year, CMS is proposing to add an additional nine categories of conditions that when acquired in the hospital will no longer lead to higher Medicare payment, including one from the NQF Never Event list associated with hypoglycemia.  Beginning October 1, 2008, Medicare will no longer pay at a higher weighted MS-DRG for the original eight conditions, as well as any conditions CMS is proposing to add in this year’s rule.

COLLABORATING TO IMPROVE QUALITY:

CMS worked with public health and infectious disease professionals from the Centers for Disease Control and Prevention (CDC) to: 

1. identify candidate preventable HACs and
2. develop the process for hospitals to submit a POA indicator for each diagnosis listed on IPPS hospital Medicare claims.

On December 17, 2007, CMS and CDC hosted a jointly-sponsored HAC and POA Listening Session to receive input from hospital associations and other interested individuals.  CMS and CDC received informal comments during the listening session and subsequently received numerous written comments.  The agenda, presentations, audio file, and written transcript of the Listening Session are available at: 

http://www.cms.hhs.gov/HospitalAcqCond/07_EducationalResources.asp. 

CMS is seeking public comment on enhancements to the preventable HAC policy, including the relationship of HACs to the National Quality Forum’s (NQF) list of Serious Reportable Adverse Events (“never events”).  As we noted last year, CMS adopted several items from the NQF’s list of events as HACs, including retained foreign object after surgery, air embolism, blood incompatibility, stage III & IV pressure ulcers, falls, electric shock, and burns.  CMS is now seeking comments regarding our proposal to add glycemic control, including hypoglycemic coma, to the list of selected conditions that will no longer result in higher Medicare payment when acquired in the hospital.  Hypoglycemic coma is closely related to NQF’s listing of death or serious disability associated with hypoglycemia.  The complete list of NQF’s Never Events and their status as HACs for purposes of the IPPS is attached.

Comments on the proposed rule will be accepted through June 13.  CMS will respond to comments in a final rule to be issued on or before August 1, 2008.

RELATIONSHIP OF HOSPITAL-ACQUIRED CONDITIONS TO THE NATIONAL QUALITY FORUM’S LIST OF SERIOUS REPORTABLE ADVERSE EVENTS (“NEVER EVENTS”)

* Death/disability associated with electric shock, burns, or falls within a facility are grouped for purposes of the Hospital-Acquired Conditions into one HAC.

# # #