February 2016
Swank Health: Your monthly news from Swank HealthCare


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In This Issue

Did You Know?

Hospital-Acquired Conditions

What's Going On?

Learn how the Swank HealthCare Advantage has helped another hospital save big!

Top List

The top 10 strategies an organization can use to maximize performance on the prevention of hospital-acquired conditions

Now Trending

See how you score on these HAC quiz questions

Recommended Readings

Recommended Courses
  • 311214 / 18715 / 22014 / 15214 Medical Errors: Facility Concerns
  • 67415 / 311314 / 18815 / 22114 / 15314 Medical Errors: Specific Patient Population Concerns and Reporting
  • 21814 / 13014 / 36614 Medical Errors: Part 1
  • 21914 / 13114 / 310714 Medical Errors: Part 2

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Did You Know?

Hospital-Acquired Conditions

In December, the Centers for Medicare and Medicaid Services (CMS) reported that 758 hospitals are subject to a 1% payment reduction applied to all Medicare discharges between October 1, 2015 and September 30, 2016 as part of the Hospital-Acquired Condition (HAC) Program. A HAC is an undesirable medical condition or complication a patient develops during a hospital stay. Penalized hospitals make up approximately 23% of the 3,308 participating in the HAC Program. The number of hospitals receiving a payment reduction in FY 2016 increased by 34 from the previous year.

Although a 1% reduction in Medicare reimbursement may not sound like much, it could make a significant difference in a hospital’s ability to survive in today’s highly competitive market with shrinking margins. For example, if a hospital’s annual patient revenue is $1.5 billion and about 25% comes from CMS reimbursement, that’s $375 million. A 10% penalty is $37.5 million. These are dollars an organization needs for things like facility improvements, staff salaries and benefits, and equipment.

The CMS HAC Program calculates payment adjustments by collecting measures from hospitals in two domains. Domain 1 is a composite score for HACs included in the AHRQ’s PSI 90 Composite. Domain 2 includes HACs within the CDC National Healthcare Safety Network (NHSN) Measures. Domain 1 is weighted at 25% and Domain 2 at 75%. After weighting is applied, the sum of the two domains make up a hospital’s overall HAC score. Hospitals with scores in the bottom 25% (worst performing quartile) receive a 1% payment reduction. HAC measures for each domain are listed below.

Domain 1

  • Pressure ulcer
  • Iatrogenic pneumothorax rate
  • Central venous catheter-related blood stream infection
  • Postoperative hip fracture
  • Postoperative pulmonary embolism
    (PE or deep vein thrombosis (DVT) rate)
  • Postoperative sepsis
  • Wound dehiscence
  • Accidental puncture and laceration

Domain 2

  • Central line-associated blood stream infection
  • Catheter-associated urinary tract infection
  • Surgical site infection
    • Added for FY2017 – MRSA Bacteremia
    • Added for FY2017 – Clostridium difficile (CDI)

Hospitals and other groups, such as the American Medical Association, have sharply criticized the CMS HAC Program. According to a 2015 JAMA article, studies show that “penalization in the HAC program may not reflect poor quality of care, but rather measurement validity issues in component measures.” “Among participating hospitals, those that were penalized more frequently had quality accreditations, offered advanced services, were major teaching institutions, and had better performance on other process and outcome measures.” Examples of these factors are:

  • Hospitals that look more thoroughly for adverse events frequently identify more events and incorrectly appear to have worse performance. For instance, hospitals that more frequently use imaging studies to look for venous thromboembolism (VTE), have higher VTE rates. Those with sophisticated electronic surveillance systems identify more infections than those where surveillance is done manually.
  • Hospitals serving greater numbers of vulnerable or medically complex patient populations are penalized more often. These include teaching and safety-net hospitals.
  • Penalization rates in smaller hospitals are often lower because those with fewer than 3 discharges for any component of PSI-90 have the national rate substituted for the hospital rate of that component when calculating the overall score.
  • Some measures lack clarity in definition, and therefore, require subjective interpretation for reporting purposes.

Despite these concerns, CMS has indicated little or no change for the HAC Program in terms of how hospitals will be scored or penalized. Organizations must aggressively implement measures to improve performance if they hope to avoid future penalties.


What's Going On?

Learn how the Swank HealthCare Advantage has helped another hospital save big!

Our goal at Swank HealthCare is to provide an education system for healthcare that not only saves money, but also helps increase efficiencies and is flexible to fit the unique needs of your facility. Read how Swank HealthCare was able to help one hospital save big in just one year!

Want to highlight your hospital? Contact your account manager and we'll work directly with you to identify your return on investment.


Top List

Here are the top 10 strategies an organization can use to maximize performance on the prevention of hospital-acquired conditions.

  1. Educate staff and physicians about:
    • HACs and prevention measures
    • Evidence-based guidelines
    • Assessing patient risk for HACs
    • Communication and teamwork
    • Patient education
  2. Assess the organization’s HAC risks based on services provided, patient populations, and performance history
  3. Implement HAC policies and procedures based on evidence-based guidelines
  4. Continuously monitor performance on HACs through surveillance, rounding, event reporting, and other means
  5. Foster a culture of safety and evaluate regularly. Staff should feel safe to speak up about and report patient safety events, including Close Calls, No Harm, Temporary Harm, and Sentinel Events without fear of punishment
  6. Standardize processes, procedures, equipment and tasks. Systems should make it difficult to make mistakes and easy to do the right thing
  7. Support strict adherence to hand hygiene and other infection control standards
  8. Identify patients at highest risk for HACs and allocate resources and prevention strategies accordingly
  9. Use checklists and other tools to ensure complete and accurate actions are implemented
  10. Educate patients and family members about ways they can help minimize the risk of HACs

Now Trending

See how you score on these HAC quiz questions.

Which of the following HACs has the highest estimated cost?

A.  Falls
B.  Pressure Ulcers
C.  Postoperative Venous Thromboembolism
D.  Surgical Site Infection

According to a 2015 report by the Agency for Healthcare Research and Quality, the incidence of HACs fell by             % from 2010 to 2014 across
the U.S.

A.  7%
B.  17%
C.  37%
D.  57%

According to the CDC, as of 2013, the most significant progress in reducing HACs in the U.S. occurred with              where rates have fallen
by 46%.

A.  CLABSI
B.  Surgical-site infections
C.  CAUTI
D.  MRSA Bacteremia


Recommended Readings


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Answer

D.  Surgical Site Infection at $21,000 per case.

Pressure Ulcers = $17,000
Postoperative VTE = $8,000
Falls = $7,234

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Answer

B.  17%

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Answer

A.  Central Line-Associated Bloodstream Infections (CLABSI)

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