CMS looks to drive quality improvement
CMS looks to drive quality improvement
A leading official from the Centers for Medicare & Medicaid Services (CMS) in Boston says that the impetus behind its list of hospital-acquired conditions for which it will no longer pay the "bump-up" in the complexity rate is a desire to improve quality of care. Some of the fears expressed by ED experts may be unfounded, he says.
"We are trying to incentivize things that are done routinely or should be done anyway, but we're not introducing another layer of bureaucracy into this," says William Kassler, MD, MPH, chief medical officer for the New England region of CMS.
Kassler offers the example of pressure ulcers. "The ED doc more than likely will have to look at patients from nursing homes to see if they have ulcers, but that's not documentation. It is quality of care," he says. "Having patients who come into the ED in a wheelchair from a nursing home examined for pressure ulcers is good care, and the documentation is no more onerous than any other aspect of notes."
What's more, he says, in the case of patients such as these, the hospital likely will not suffer financially, even if such conditions are discovered after admission. "We've done our analysis, and most of the patients who would fall under these conditions are likely to earn [the additional payment] for other conditions," Kassler notes. "If they have multiple problems and comorbidities, there is an overwhelming likelihood they will get some payment for a different reason, so we think this is far more about stimulating quality than it is about saving money."
While conceding that these rules likely will drive differences in ED behavior, Kassler says CMS will be reasonable. "If someone has a fracture and is in pain, do you have to stop treating the pain to do a box-checking exercise? That's not what we're talking about," he says.
In the case of infection in the ED, he says, the required documentation will be part of the work-up. "The clinical work necessary to take care of a patient with fever is sufficient for documentation," he says. "If you do not know if a patient has a urinary tract infection you do a history, an exam, and lab tests, the diagnostic work-up is routine care, and documentation is routine." The coder ultimately will need to sum up the case, he explains, and "put present on admission" or not.
Source
For more information on how the Centers for Medicare & Medicaid Services views regulations concerning hospital-acquired conditions, contact:
- William Kassler, MD, MPH, Chief Medical Officer, New England Region, Centers for Medicare & Medicaid Services, Boston. Phone: (617) 565-1319.
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