Drug Topics - October 22, 2007 - (Page H1)

www.drugtopics.com OCTOBER 22, 2007 DRUG TOPICS HSE 1 R.Ph.s brace for payment denial for hospital-acquired conditions Jillene Magill-Lewis, R.Ph. T he Centers for Medicare & Medicaid Services untarily ceased charging for any of the preventable events on will soon be denying reimbursement for certain NQF’s list. Other hospitals in the state may soon follow suit. hospital-acquired conditions (HACs), according The new rules taking effect nationally and in individto new rules published this year. Denying payment for ual states will require hospitals to make changes. First and HACs is a new step for CMS, and it reflects foremost, hospitals must be sure all primary a recent trend in healthcare reimbursement, and secondary diagnoses are noted upon adsaid Kasey Thompson, Pharm.D., director of mission. A diagnosis made after admission patient safety for ASHP. may result in nonpayment. CMS has adopted a handful of events from With new challenges come opportunities for a list endorsed by the National Quality Forum. improvement, but “there’s always the potential In 2002, NQF endorsed a list of 27 serious adfor untoward consequences,” Thompson said. verse healthcare events that are preventable and For example, it’s possible that in order to preof significant concern to healthcare providers vent infection, too many patients could be put and patients. Several of these events, CMS has on unnecessary prophylactic antibiotics. Michael Sanborn determined, are clearly preventable. Therefore, warns med errors “The value of the pharmacist in these proeffective Oct. 1, 2008, CMS will not pay hos- probably won’t be grams is significant,” he said. Monitoring appitals for additional costs incurred by any of the paid down the line. propriate antibiotic use will be a key function following conditions occurring after admission: pressure health-system R.Ph.s can perform. ulcers, blood incompatibility, air embolisms, objects inadvertently left in patients during surgery, hospital-acquired Checking it twice injuries (burns, fractures, dislocations), catheter-associated Although medication errors can cause significant harm, infections (urinary and vascular catheters), and infections this preventable occurrence is associated with coronary artery bypass graft surgery. notably missing from CMS’ list. “ASHP fundamentally supports what CMS is doing,” That’s probably because there is “It’s difficult to said Thompson. “It’s hard not to support it.” It’s difficult to no code yet for medication erargue against denying payment for mistakes and preventa- rors, said Michael D. Sanborn, argue against denying ble occurrences, he explained. Considering NQF’s list of B.S., M.S., corporate director of payment for mistakes and preventable conditions is much longer, this pared-down pharmacy for Baylor Healthcare version is quite conservative. What’s more, the conditions System, Dallas. With all the evi- preventable occurrences.” CMS has selected for nonpayment are difficult to dispute. dence available on injuries Kasey Thompson, ASHP caused by medication errors, One step further Sanborn believes it’s only a matter of time before payers Minnesota hospitals are taking reform one step further. deny payment for this type of injury as well. On Sept. 18, Gov. Tim Pawlenty announced hospitals will Meanwhile, health-system R.Ph.s can help prevent not bill patients or their insurers for any of NQF’s 27 types HACs in many ways. “One big thing is hand washing,” said of preventable adverse health events. “It seems obvious to Sanborn. Pharmacists should be sure they and everyone us, but Minnesota is the first state in the nation to agree with patient contact are practicing good infection control that patients, employers, and insurers shouldn’t pay for care measures. Pharmacists should also participate in fall commade necessary by an adverse health event,” Pawlenty said. mittees, he said, because they can help identify drugs and Although Massachusetts does not have a similar law, just other hazards that make patients more susceptible to falls. over half of the state’s hospitals have adopted the policy of Said Thompson: “Pharmacists will play a very, very not charging patients or their insurers for errors. According critical role.” to Leapfrog Group, 33 of the state’s 61 hospitals have vol- THE AUTHOR is a writer based in the Seattle area. http://www.drugtopics.com

Table of Contents Feed for the Digital Edition of Drug Topics - October 22, 2007

Drug Topics - October 22, 2007 Contents Latebreakers Legislative Victory Builds Momentum for Pharmacy Month Letters Health-System Edition R.Ph.s Brace for Payment Denial for Hospital-Acquired Conditions Topical Human Thrombin Helps Arrest Bleeding FDA Panels Fail to Set Target Levels for Renal Patients’ Hemoglobin Warning Letters Raise Patient Safety Concerns for Fentora Ending/Reversing Weight Gain Man Given Fatal Drug Overdose at Staten Island Hospital Pharmacists Playing More Important Role in Dialysis Treatment AHA President R.Ph.'s Here's How You Can Increase Your Value Premier Launches Comprehensive Quality Improvement Project FDA Approves Dexrazoxane for Treatment of Extravasation New Federal, State Reforms to Ease Disaster Relief Kinks 150 Years of American Pharmacy Ten Tips for MTM Success Independent Superstars: The Ones to Watch The New Dynamic Duo A Parkinson's Disease Primer Classified New Products Advertisers Index Viewpoint

Drug Topics - October 22, 2007

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