Adverse Hospital Infection Rates In Hospitals

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 of experience, knowledge, and capabilities that would enable them to successfully own the cost of their population, and this is a gap that Medtronic can address.

The proposal for bundled payments (CCJR) will force hospitals and other health care facilities to change and adapt. The proposal would include medical severity diagnostic-related groups which would help calculate targeted prices for each severity group and each hospital separately. Several controversial components would be included in the proposal. Mandatory participation is one of the key requirements to the proposal. Another controversial component to the CCJR program is that hospitals would be exclusively responsible for the bundled payment program and any financial excess. However, these controversial components are key features to ensuring the proposal’s success which will help patients and providers in the future. Another reason the CCJR proposal will force hospitals to adapt is that the hospitals would be financially accountable for the quality of care. If the hospitals fail to meet three specifically designed protocols for quality, the hospital(s) would be ineligible for savings

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,

Quality and financial viability being closely tied is an extremely salient point. Furthermore, the Affordable Care Act has influenced the requirement for high-quality, cost-effective care provision by implementing Value Based Purchasing (Aroh, Colella, Douglas, & Eddings, 2015). In addition, there are presently Centers for Medicare and Medicaid (CMS) quality indicators that effect reimbursement for hospitals (Xu, Burgess Jr, Cabral, Soria-Saucedo, & Kazis, 2015). For example, if a facility does not meet the indicator threshold for catheter associated urinary tract infections, central line infections and/or pressure ulcers their reimbursement is affected. Given that the quality of care provided by a hospital is

With new reforms being put in place under the Affordable Care Act such as the pay-for-performance (P4P) also known as “value-based purchasing,” which is intended to help provide maintain and efficient programs to improve health care cost. Healthcare providers, hospitals, medical groups, and physicians are offered incentives for meeting certain performance goals; it also fines for increased costs and medical errors such as incorrect medication or dosages. In two different studies quality of care was found to have improved at P4P hospitals compared to non-P4P hospitals Lindenauer et al. (2007) and Grossbart (2006). However, a study by Werner et al.(2011) found no continuing benefits in quality of care. One measure being advocated for is the Hospital Readmissions Reduction Program (HRRP) to prevent hospital readmissions as a way to improve the quality of care and at the same time cut cost. If patients are readmitted within 30 days after discharges due to conditions like acute myocardial infarction (AMI), heart failure, and pneumonia, fines can be levied such as 1 percent of Medicare payments. Others include the Hospital Value-Based Purchasing (VBP) is based on how well the hospital performs compared to other hospitals or the improvement of their own performance compared to a baseline time. The goal is to encourage better outcomes for patients and improve experience during hospital stays. And the Hospital-Acquired Condition (HAC) Reduction Program motivates hospitals to increase the safety of it patients by cut the number of hospital-acquired conditions and patient safety (Medicare.gov, n.d.) (Kruse, Polsky, Stuart, & Werner, 2012)(Gu et al.,

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) .

This savings would be a direct result of decreased overpayment by Medicare to hospitals, physicians and insurance companies (Perez, 2013). As a result, Centers for Medicare and Medicaid is incentivizing increased quality care in hospitals. Consequently, hospitals are not getting reimbursed for hospital acquired conditions. In addition, CMS is penalizing hospitals for readmissions (Bauchner, 2015). Lawmakers are expecting resounding savings related to CMS expectations. The short term savings of more than $200 billion through 2016 (CMS, 2015). As a result, hospitals are in a paradigm shift from volume based care to value based care. The expectation is that hospitals will reduce waste and decrease inappropriate waste which will result in savings that be used for other therapies (Bauchner,

Thus, a challenging task hospital administrators must overcome is determining how to align financial incentives to match quality measures in the ER. On the opposing end, insurance companies have already begun creating a financial incentive for patients to stop visiting the ED. A study by the NEHI (2010) found that increasing the co-payments associated with ED visits will significantly reduce ED usage. The NEHI (2010) states increasing the co-payment for these visits up to $50-$100 has decreased the ED use by 23 percent. Indubitably, costs of care will continue to be a driving force of decisions regarding the ED in every component of the health care

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.

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.

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

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.

Health-care associated infections (HAI), which individuals obtain while they are receiving healthcare for another condition, have been prevalent for many years in health care. These infections have led to the loss of tens of thousands of lives and have cost the U.S. health care system billions of dollars each year as they are a significant cause of illness and death (ODPHP, 2017). The Healthcare-associated infections Action Plan, developed by the US Department of Health and Human Services, was developed to provide a map for preventing HAIs in these health care facilities. The purpose of this paper is to discuss how the prevention of HAI provision of the ACA is intended to achieve higher value, synthesize evidence that the policy has

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