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CMS Will No Longer Pay for Hospital-Acquired Infections
The Centers for Medicare and Medicaid Services (CMS) announced last month that Medicare will no longer reimburse health care providers for the extra costs incurred when beneficiaries contract certain hospital-acquired infections (HAIs).

Each year, some 2 million hospital patients acquire an infection during their stay, and nearly 100,000 patients die from these infections, according to the Centers for Disease Control and Prevention. Treating HAIs adds an average $15,000 to patient bills, totaling about $30 billion annually. According to the most recent Leapfrog Hospital Quality and Safety Survey, 87 percent of U.S. hospitals do not follow all of the recommended practices to prevent most HAIs, including hand-washing—the first line of defense against many infections.

Beginning in October 2008, Medicare will end payments to hospitals for treating common HAIs, including catheter-associated urinary infections, bloodstream infections, and surgical site infections. CMS also will withhold payment for other complications considered preventable, including injuries resulting from falls, bed sores, and objects left in patients during surgery. To implement this policy, hospitals will be required to report secondary diagnoses present during admission, making it possible to detect what conditions were acquired during hospital stays. The new rules are part of several payment reforms intended to improve the quality and efficiency of Medicare.

QIOs Target Prescription Drug Therapy
The Medicare Modernization Act of 2003 gave Quality Improvement Organizations (QIOs) a new line of work: improving the quality and safety of drug prescribing and use among Medicare beneficiaries. It also gave them wide latitude in pursuing this goal.

According to a recent Journal of Managed Care Pharmacy supplement, QIOs across the nation have taken various approaches to improve prescribing, including: working to promote safer alternatives to the use of drugs known to produce adverse effects among elderly patients; improving medication use among diabetics; educating providers and beneficiaries who have high medication use about medication therapy programs; reporting comparative performance information among different health plans; and creating systems in which health care professionals can work together to improve medication reconciliation.

UnitedHealth to Test Medical Home Concept
Last month, UnitedHealth Group, one of the nation's largest commercial insurers, announced that it will test the efficacy of the "medical home" concept. This is the first time this model—centered on primary care practices that provide accessible, continuous, and coordinated care—will be put into practice by a private health plan. Medical homes have been advocated by several medical professional societies and linked to better-quality care in a recent Commonwealth Fund report.

UnitedHealth Group will partner with six primary care practices in Florida to test the model, and patients will be offered the option of choosing to register with a medical home. UnitedHealth will then offer enhanced reimbursement to physicians who offer medical homes, and who can demonstrate measurable improvement in the overall health of their patients.

To improve access to care, the insurer will offer round-the-clock triage services by nurses, and provide educational tools to patients. They will also work to identify and reach out to patients who need care, and provide assistance to help patients manage their conditions.

Leapfrog Group Names 41 "Top Hospitals"
Based on the results of its annual Hospital Quality and Safety Survey, the Leapfrog Group has named 41 hospitals high performers for 2007. The results, released Sept. 18, are based on responses from 44 percent of the urban, general acute-care hospitals in the 33 regions targeted by the survey, or 1,285 hospitals.

Leapfrog collects data from hospitals on their progress in four areas: implementation of computerized physician order entry; ICU physician staffing; evidence-based hospital referral; and adherence to Leapfrog's designated safe practices. Seventy-four percent of participating hospitals have fully implemented the practices in at least one of these four categories.

"Top Hospitals" fully meet Leapfrog's standards for ICU physician staffing and safe practices and follow either 1) two or more of the eight evidence-based hospital referral (EBHR) practices or 2) have computerized physician order entry plus one of the eight EBHR practices. Thirty-three general hospitals meet these criteria. "Top Children's Hospitals" fully meet the standard for ICU physician staffing, safe practices, and the EBHR Neonatal ICU standard for high-risk newborns. Eight children's hospitals meet these criteria. The complete list and a detailed explanation of the methodology can be found at the Leapfrog Group Web site.

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