Drug Topics - May 12, 2008 - (Page HSE10)

10 HSE DRUG TOPICS MAY 12, 2008 www.drugtopics.com > > > Special Report covered by Medicare if they occur after admission. The new conditions include: • Surgical site infections following certain elective procedures • Legionnaires’ disease (a pneumonia caused by a specific bacterium) • Extreme blood sugar derangement • Iatrogenic pneumothorax (collapse of the lung) • Delirium • Ventilator-associated pneumonia • Deep vein thrombosis/Pulmonary embolism (formation/movement of a blood clot) • Staphylococcus aureus septicemia (bloodstream infection) • Clostridium difficile-associated disease (a bacterium that causes severe diarrhea and more serious intestinal conditions such as colitis) Pharmacists have important role “The single most important implication for health-system pharmacists is that metrics are absolutely crucial. In fact, it is critical that pharmacies be able to indentify the costs associated with all aspects of the medication use process. They should be able to go to their administrators and demonstrate how much drug cost money is at risk if, for example, catheter-associated urinary tract infections do occur,” said Bonnie Kirschenbaum, M.S., a healthcare consultant in Breckenridge, Colo., who specializes in pharmacy reimbursements. This could “change the behavior pattern at the facility level,” added Kirschenbaum, “and that is the kind of responsibility pharmacists should be assuming in order to effectively create pharmacy budgets.” Pane noted that the changes by CMS can offer enhanced “opportunities for pharmacy to play a role in preventing some complications from occurring. For example, for surgical site infections, pharmacists can make certain the correct anti-infective is being utilized pre-op and post-op. And pharmacists can assist labs and blood banks by developing bar codes for bedside verification, to avoid patients receiving incorrect blood products.” In addition to the new nine conditions, CMS announced on April 14 that it proposes adding 43 new quality measures to the existing 30 in its voluntary reporting of standardized quality measures. These are measures that are publicly reported on Hospital Compare, a Web site that shows how acute-care facilities are performing. The agency must receive data about these measures for a hospital to receive its full inflation update for fiscal year 2010. The additional measures, if adopted in the final rule following a public comment period, will take effect October 1, 2008, for fiscal year 2009. The proposed additions include: • Surgical Care Improvement Project (one new measure) • Hospital readmissions (three new measures) • Nursing care • Patient safety indicators developed by the Agency for Healthcare Research and Quality (five new measures) • Inpatient quality indicators developed by AHRQ (four new measures) • Venous thromboembolism measures (six new measures) • Stroke measures (five new measures) • Cardiac surgery measures (15 new measures) Private payers But the effect of these CMS rules goes beyond federal reimbursement. Private payers are emulating CMS, at least as far as the more egregious errors are concerned. Aetna is stipulating in new hospital contracts that it will no longer pay nor let patients be billed for the 28 different “never events” compiled by the National Quality Forum (NQF), such as operating on the wrong limb. WellPoint, the largest insurer by members, is doing the same thing in Virginia with four errors from the NQF never-events list. Officials have announced that they plan to extend the policy to its plans in New England, New York, and Georgia. UnitedHealth Group and Cigna officials said they will be following suit sometime this year. And the Blue Cross Blue Shield Association officials have stated publicly that all of its 39 member health plans are looking at similar measures. The amount of money saved may be minimal, however. In Minnesota, where hospitals are required by law to report such errors, 154 NQF never events were reported last year out of nine million hospital admissions, according to recent reports. However, the move by CMS to MS-DRGs—with its emphasis on hospital-acquired and preventable infections—is expected to save the federal government $20 million in FY 2009, according to a CMS statement. Although CMS does allow a 60-day “review process” for MS-DRG reimbursement, there is no formal appeals process. “It’s fairly well recognized and agreed upon that there are too many hospital-acquired infections and that a vast majority of those are in fact preventable,” Thompson said. “But it is likely that some, if not the majority, may not be preventable. And then hospitals should have the ability to appeal Medicare’s decision not to pay the additional costs of the infection.” THE AUTHOR is a writer based in Gettysburg, Pa. http://www.drugtopics.com

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Drug Topics - May 12, 2008 Contents Latebreakers Letters R.Ph.s Say More Needs to be Done to Prevent Pediatric Drug Errors There's a New School of Thought on Use of Beta-Blockers for Hypertension Cover Story Guest Spot Letters Clinical Practice Special Report Professional Practice Broad Label for New Leukemia Therapy Looks Promising Treating Asthma During Pregnancy Safer than Not, Says New Guide In the Pipeline Clinical Q&A APhA Leader's Plan to Leave Office Takes Center Stage at its Conference Policies Passed at a Glance Giving a Talk to the Community? Check Out These Materials This Foundation has Funds to Spare JP at Large Cover Story: Employers and R.Ph.S: A Win-Win Combo FDA's Ilisa Bernstein Discusses Pharmacy Affairs Legal Q&A Manufacturers Unleash a Rash of Poison Ivy Treatments Are OTC Cold Remedies Safe for Kids? Probiotics are All the Rage: How You Can Capitalize on It CMS' Prices for Round One of DMEPOS Competitive Bidding Raising Concerns CVS Caremark's Mentoring Program Recruits and Retains R.Ph.s Antibiotic Resistance Among Community Pathogens Technology Update New Products Advertisers Index Classified Viewpoint

Drug Topics - May 12, 2008

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