Using Operational/Environmental Methods to Prevent Costly CMS Readmission Fines due to Healthcare-Associated Infections (HAI’s)

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By Randall B. Charpentier, HEM, President/Principal Consultant: HealthSafe New England

Introduction

Kaiser Health News (KHN) reviewed recent federal records from the Centers for Medicare & Medicaid Services (CMS) 120px-3D_Judges_Gavelregarding fines issued to hospitals for having too many patients return within a month for additional treatments.  Of the roughly 5,700 hospitals registered  in the USA, 2610 hospitals were subjected to fines, almost half of all registered hospitals!  Read KHN review here.

Under the new fines, three-quarters of hospitals that are subject to the Hospital Readmissions Reduction Program are being penalized. That means that from Oct. 1 through next Sept. 30, they will receive lower payments for every Medicare patient stay — not just for those patients who are readmitted. Over the course of the year, the fines will total about $428 million, Medicare estimates.

In light of this monumental shift for the healthcare industry on how reimbursement rates will impact their services and bottom line, this article by Forbes Contributor, Dan Munro; Government Drops Big Bombshell on U.S. Hospital Industry prompted me to ask the question:

How will hospital leaders respond to this unknown impact on patient lives and their operating budget?

The Healthcare industry is currently undergoing a complete transformation of how it conducts business and serves the U.S. population and foreign nationals with their healthcare needs. Not only is CMS fining facilities, they are reducing their reimbursement rates based on quality and safety. The operational and financial impacts should be resounding. Healthcare executives will be forced to reexamine top to bottom how they deliver their services with better results, higher quality and lower costs.   The status quo will no longer survive in this new environment, in other words this action is a game changer for the entire industry. In light of the Ebola episode and the lack of preparedness of healthcare facilities to deal with what appeared to be a breakdown in protocols, and the lack of direction from the CDC, this industry is reeling.

One particular area to address are the operational issues and physical environment in combating HAI’s. HAI’s are one of the leading causes of hospital readmissions  with more questions than answers as to how hospitals will address them. It can be done as highlighted in my recent blogpost about best practices for preventative measures relative to construction & maintenance in healthcare.

Maybe these fines won’t capture the C-Suites attention, but certainly the negative press will. No hospital in this country wants a reputation of being unsafe or appearing on the front page of the newspaper or headline news as being one that has been fined for high readmissions. Once CMS has identified you, chances are that you will have a difficult time extracting your organization and facility from their cross hairs. This is one in a series of blogs that are intended to address the physical environment, healthcare culture and the role it plays in contributing to HAI’s .

In this blog series, I will  share my experience as it relates to operational/environmental related HAI’s, contributing factors, and potential solutions based on what I’ve observed as challenges and best practices, as a seasoned professional in my roles as a Healthcare Safety/Risk Management Consultant, Industrial Hygienist, Healthcare Safety Officer, Insurance Risk/Loss Control Professional, and consumer of healthcare services.

The areas I’ll address include:

  • Hand Hygiene
  • Personal Protective Equipment
  • Ventilation
  • Emergency Responses
  • Technology

Randy Charpentier

Randall Charpentier is a 20 year experienced, safety and risk management consultant specializing in healthcare compliance and best practice management. Project experience ranges from leading teams on the construction of the west coast space shuttle project, working internationally & domestically for leading environmental engineering firms conducting real estate assessments involving occupational and environmental risks, assessing business operational risks concerning commercial insurance policies, and reducing/eliminating exposures/hazards, to leading world renowned, top ten/one hundred community based & BioMedical Research/Teaching hospitals, with development and execution of best practices with EOC, Fire/Life Safety, Infection Prevention in Healthcare Construction, and Emergency Management programs.  HSNE’s/Randall’s passion is keeping patients, staff and visitors safe in a healthcare setting.  CMS is measuring safety and quality in healthcare facilities basing reimbursement on healthcare outcomes. Does your facility measure up? If not, you should conduct a risk assessment. Is your facility compliance or results driven? To find out, contact rcharp@hsnellc.com or www.hsnellc.com, or LinkedIn profile.

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