Adverse Hospital Infection Rates In Hospitals

In the past several years, there have been several changes in economic policy at federal and state levels. The two economic policies that present to be the most precedent for healthcare leaders with concern to facility reimbursement are the Affordable Care Act (ACA) and the switch from volume to value reimbursement. First, there is the ACA policy, which have affected healthcare facilities and their reimbursement methods. In fact, ever since this policy was implemented, provider reimbursement has started to decrease in terms of fee-for-service payments (The Common-Wealth Fund, 2015). In other words, the intention of this policy was to provide budget relief to the government payers as well as giving providers an incentive to provider patients with great quality of care.

Hospital acquired infections (HAI) will begin to display signs and symptoms within 48 hours. In order to treat the infections, physicians need to diagnostic tools quickly. The manufacturer of new diagnostic test makers, Kalorama Information stated last year that the world demand for testing and treatment of HAI will be over 10 billion dollars by the year 2015, increasing from 9 billion dollars in 2010. Kalorama also stated that HAI has a 5% infection rate of 40 million hospital visits a year, causing 100,000 deaths in the U.S. annually (Kalorama Information, July 14, 2011). Early diagnosis will improve the patient's outcome and decrease the chance of death. According to Kalorama, 20-30% of the HAI can be prevented by the simple use of better hand washing and cross contamination avoidance although the others need more intensive changes such as hospital ventilation systems and using more disposable supplies (Kalorama Information, p. 113) .

Introduction: Hospital-acquired infections (HAI) affect 1.7 million Americans each year with as many as 98,000 dying annually as a result of hospital-acquired conditions (HAC) (Kavanagh, 2007). In 2008, the Centers for Medicare and Medicaid Services (CMS) implemented policy to include non-payment for HAC in order to improve quality patient care and contain costs. This non-payment disincentive refuses to pay for complications of care that are considered preventable. Two other paradigms of this policy used to promote quality include pay-for-performance initiatives and public disclosure of HAC.

In recent years, emphasis has been placed on improving the quality of health care services and the overall patient experience. Innovative measures are needed to meet these expectations, while also containing the rising costs of health care. The government has enacted new laws in attempts to provide incentives that base Medicare payments in part on quality. In fact, the Patient Protection and Affordable Care Act of 2010, requires the implementation of value-based purchasing (VBP), which bases Medicare reimbursement rates on the quality of care (Kennedy, Wetzel & Wright, 2013). Hospitals may experience a decrease in revenue initially, however, it is theorized that the increase of transparency and accountability will serve as an incentive for improvements in the overall quality of care provided in the United States.

Individuals in residential care settings are vulnerable and are often more likely to develop infections. There are many reasons for their vulnerability including frailty, pre-existing conditions, and weakened immune systems. They may not be able to fully communicate with healthcare workers to report changes in health or may be too embarrassed by their decline in health to report the changes. Because of this, it is very important for residential care workers to ensure that infection control and prevention measures are implemented. Infections can cause many unwanted side effects in patients such as pain, discomfort, disorientation, and even in severe cases death. Not all infections can be passed from person to person. However, in residential care settings, many infections that can be passed from person to

1) CMS policies push alternative Medicare payment models CMS has launched many new bundled payment plans which extend the hospital’s responsibility for care and cost outside of the inpatient stay itself. However, hospitals have been reluctant to sign on for down-side risk. They are risk-averse due to their lack

Centers for Medicare and Medicaid Services (CMS) had adopted the “no-pay” rule in the year 2008 with the objective to encourage hospitals to terminate medical complications (American Medical News, 2012; Stone, et.al., 2010). Under this rule, CMS denies the payment to the healthcare facilities for any extra cost which is involved in treating Medicare patient. This policy has the significant impact on the health care system as the hospital executives need to redefine their priorities and enhance their efforts towards improving patient care.

The Balanced Budget Act (BBA) of 1997 significantly cut Medicare In 2012, the ACA found an excessive amount of readmissions of patients that were hospitalized within 30 days for the same medical conditions. This factor viewed under the ACA as a quality issue and CMS implemented value-based incentive payments based on performance in a set of quality measures. The plan is to implement a pay for performance (P4P) in formulas used by Medicare to reimbursement providers. “The objective is to link reimbursement to quality and efficiency as an incentive to improve the quality of health care, as well as reduce system-wide costs” (Shi and Singh, 2015). In addition to the P4P, nonprofit hospitals also focus on continual improvement, data and cost containment throughout the organization (Adamopoulos,

Hospitals are viewed unfavorably by most patients for the elevated (and often surprise) costs, care quality, and their lack of follow up to the provided care. “Who could feel sympathy for a billion-dollar corporation?” (Gunderman, 2013). Our payor-driven (as opposed to consumer-driven) health system has resulted in inflated costs, increased waste, and a race where executives continuously search for ways to increase their revenue share to stay relevant in market size, instead of improving patient care quality. Unfortunately, the increased level utilization linked payment system discourages investment in the most basic mantra: health quality.

Becker’s Hospital Review offered three value-based alternative approaches to the controversial challenges to the current health system. Becker’s review discussed holding everyone who would naturally form the ACO to be financially accountable for keeping costs down but continue to be held to a standard to improve patient health (Becker’s Hospital Review, 2011). If the time is not right to implement the ACO, the pay-for-performance and its quality performance model can still be utilized; the bundled payments option and its episode of care option of paying for single use; and the medical home reimbursement tool that has already been proven to lower costs and improve satisfaction, are all models that can be used if the time is not right for the

For the most part, I can correlate my findings with this week’s reading and lecture. With the introduction of ACA, emphasis on the quality of healthcare and patient safety has grown significantly since reimbursement is directly linked to it. ACA has enacted various provisions to improve the quality of care and reduce the cost of healthcare. These provisions are, “incentive to reduce Medicare readmissions, incentive to reduce hospital-acquired conditions, pay for value programs for hospitals and physicians and bundled payment” (Blumenthal, Abrams and Nuzum, 2015).

Barrier to Implementation and the Role of APNs The major barrier to implementation of improving MRSA management through MRSA decolonization strategies is economic in nature. Financial costs are associated with both MRSA screening and decolonization strategies (Nelson, Samore, Smith, Harbarth, & Rubin, 2010). As an APN, the author was trained to analyze healthcare policies and submit recommendations that could further improve patient healthcare outcomes. The author believes that the hospital business administrators will be alarmed once she submits the proposal for adding MRSA screening and decolonization guidelines to the hospital’s policy on SSI prevention. Typically, hospitals try to avoid spending money on things that they do not see immediate

I chose the topic of hospital acquired blood stream infections because it raises a serious concern in the health care industry. As a nurse it is important to be educated on how this infection occurs and ways that it can be prevented. Being educated on this topic will affect my overall clinical decision-making and help me grow as a nurse. Educating nurses on this issue can save a great amount of lives and money. I will use this information in my nursing practice by making sure to use the proper techniques so that this issue does not continue and my patients get the care that they deserve. It is my responsibility as a nurse to create a healthy and safe environment for patients. Ways that I can reduce the number of patients affected my blood stream

The impact of Centers for Medicare and Medicaid Services (CMS) payment denial on the healthcare system is it has forced physicians and nurses to be more diligent, hyper vigilant, and take more responsibility in care the care of patients. As nurses we all know that turning and positioning q2h helps to prevent pressure ulcers, CMS no longer pays for pressure ulcer tx that occurred after admission. CMS is making the facilities take the loss and the facility has to pay for the treatment because they didn’t prevent. The same goes for hospital acquired infections, the facilities have to pay for the tx.

Are there other reasonable explanations for the cause of the unintended injury? (No/Yes/Possibly/Not applicable) Was there an opportunity prior to the occurrence of the injury for intervention which might have prevented it? (No/Yes/Possibly/Not applicable)