In the News: Mar 7–14

Hospitals Penalized Due to Infections, Injuries

A recent Kaiser Health News article discusses the penalties 800 of the nation’s hospitals face as a result of the Hospital Acquired Conditions (HAC) Reduction Program. Created by the Patient Protection and Affordable Care Act, the HAC program penalizes hospitals based on infection rates and patient injuries.

Federal records suggest that 110 hospitals will be paid less by Medicare for the fifth year in a row. According to the Agency for Healthcare Research and Quality, hospital patients suffered an avoidable injury in 9 of every 100 patients stays in 2016. While the threat and fear of losing money encourage hospitals to improve quality, hospitals also protest the HAC penalties due to cutoffs, which they feel are arbitrary.

Sg2 believes that the financial risks for 30-day readmissions and hospital-acquired conditions provide an incentive for organizations to implement infection control measures. To learn strategies for mitigating the financial impact of hospital-acquired infections, read the Sg2 Expert Insight Antibiotic-Resistant Pathogens: More Than a Bug, Potential Business Chaos.

Hospital Medicare Margins Continue to Decline

According to a Modern Healthcare article reporting preliminary data from the Medicare Payment Advisory Commission, hospitals’ Medicare margins continue to decline. US hospitals’ Medicare margin was –9.9% in 2017, down from –9.7% in 2016. Despite this decline in Medicare margin, hospitals’ aggregate all-payer margin reached 7.1% in 2017—an increase from 6.4% in 2016. Medicare margin varied by hospital type, with not-for-profit hospitals having a Medicare margin of –11% and for-profit hospitals having a Medicare margin of –2.6%.

As the population continues to age, the share of Medicare patients will continue to expand. This payer mix erosion coupled with declining reimbursement will place increasing downward pressure on hospital margins. To learn how Sg2 can help you shore up commercial revenue, read the Sg2 Take-Action Guide on Payer Mix Erosion.

CDS System Implementation Takes Coordination, Integration

In a recent Healthcare IT News article, 3 chief information officers provided best practices for implementing clinical decision support (CDS) systems, including coordination with clinicians and  provider organizations and integration with other IT systems. The breadth of synchronization necessary for implementation makes CDS one of the tougher health care technologies to tackle. Some key takeaways include a focus on sustainable and scalable technology, an emphasis on real-time data, considerations of interface, and attention to mobile support.

As part of rulemaking under the Protecting Access to Medicare Act, CMS will require physicians to use a CMS-approved CDS mechanism to consult appropriate use criteria when ordering certain advanced imaging procedures. Since CDS is a multidisciplinary tool, effective implementation requires engaging multiple stakeholders. To learn more about CDS, listen to the Sg2 Health Tech Weekly netcast Clinical Decision Support—The Clock is Ticking.

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