Drug Topics - May 12, 2008 - (Page HSE9)

www.drugtopics.com MAY 12, 2008 DRUG TOPICS HSE 9 Special Report < < < New reimbursement benchmarks: Are you ready for them? Martin Sipkoff or the first time in a quarter century, Medicare additional DRGs and the new subclass designation is changing the way it pays hospitals—and pri- “major complication or comorbidity,” an example of vate insurers are following suit. which is severe sepsis. Beginning October 1, the Centers for Medicare & But the biggest change in MS-DRG is that for Medicaid Services is adopting a new diagnosis-related discharges occurring on or after October 1, Medicare group (DRG) reimbursement system that pays more will no longer pay the additional costs incurred by for sicker patients but is tied to the quality hospitals when certain hospital-acquired of care. Last year, CMS said it will no loninfections develop or when certain medical ger pay for eight conditions if they were not errors occur. Specifically, “hospitals will present on admission. On April 14, CMS not receive additional payment for cases announced a proposed expansion of that in which one of the selected conditions list, including nine more conditions. was not present at admission,” according “This is a move toward value-based purto the new CMS rules. “That is, the case chasing that has been coming for some would be paid as though the secondary ditime,” said Fred Pane, senior director of agnosis was not present… CMS can revise Fred Pane (top) and pharmacy affairs at Premier Inc., a group Kasey Thompson the list of conditions from time to time.” purchasing organization in Charlotte, N.C. warn that pharma- “The intent is to encourage hospitals to “Initially its impact on pharmacists may be cists should become improve the quality of care by threatening familiar with the limited, but they need to be familiar with new criteria for to withhold payment,” said Kasey Thompwhat is happening and be aware that under evaluating hospitals son, director of the practice standards and some specific circumstances, their hospital’s to maximize reimquality division at the American Society of bursement for their reimbursements may be reduced.” Health-System Pharmacists. “We will see if facilities. Pane is referring to a quality adjustment this is effective. There are some studies that mechanism in the Inpatient Prospective show that patients do get better care when Payment System (IPPS), what CMS calls health systems are financially incentivized the Medicare Severity DRG reimbursement to provide it.” system (MS-DRG). It began with the DefiThe selected eight conditions that CMS cit Reduction Act of 2005, which required will no longer pay for included hospital-acCMS to select at least two conditions that quired infections (HAIs), such as catheterthe agency considered costly or too freassociated urinary tract infections, as well as quent; that resulted in the assignment of several of what the National Quality Forum patients to a higher-paying DRG when they have that calls “never events”—errors involving death or serious condition as a secondary diagnosis after admission; medical injury that are so egregious they should never and could have been prevented through adherence occur. CMS refers to both HAIs and never events as to evidence-based guidelines. In a November 2007 “conditions,” but most are events that should not ocreport to Congress, the Department of Health & cur if a hospital is following evidence-based guidelines. Human Services stated that “value-based purchasing, These conditions “are reasonably preventable through which links payment to performance, is a key policy proper care and for which Medicare will no longer pay mechanism that CMS is proposing to transform at a higher rate if the patient acquires them during a Medicare from a passive payer of claims to an active hospital stay,” states CMS. purchaser of care.” The April 14 announcement stated that comments To that end, the new MS-DRG has 25 major on the proposed additional nine conditions will be acdisease categories, 745 diagnosis-related groups, and cepted through June 13, and the final rule will be isthree subclasses of complications and comorbidities. sued on or before August 1, 2008. The final rule will It includes the same number of major disease catego- state which of the nine conditions below will be added ries as the original system adopted in 1983, but 207 to the eight existing conditions and will no longer be F 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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