Reduction in Payments Made to Hospitals with High Complication Rates

One third of hospital acquired infections can be prevented according to epidemiological studies by well-organized infection control programs, yet only 6% to 9% are actually prevented (Use patient safety, 2000, p. 1). Fuller, McCullough & Averill (2011) believed that preventable hospital infections should be directly linked with payments made to the hospital with high complication rates. Because performance and cost is directly related to the health care system; when hospital performance lacks it puts a financial strain on the entire system, patient readmission to be specific. Experts hope that the payment adjustment factor will change the mentality of the health care workers from “this should never happen” with “this has happened to often” (p.69). The Medicare Payment Advisory Commission (MedPAC) proposed a readmission payment policy that would “reduce payments made to hospitals with relatively high readmission rates”. The rate-based policy will help to identify the cost and frequency of a post- admission complication; assess risk and preventability of infection; compare actual and risk-adjusted complication; determine hospital payment and post reduction of Diagnosis Related Group (DRG) payment (Fuller, McCullough & Averill 2011, p.71)

According to Fuller, McCullough & Averill (2011) by enacting this new policy, hospitals will be rewarded or punished based on the hospital’s overall complication rates. When hospitals focus on complication   rates rather than by case to case; their efforts for reducing hospital acquired infections is increased (p.71). For instance, it is noted by Fuller, McCullough & Averill (2011) that admitting patients are more likely to become contaminated through an admitting faculty; with this information hospitals can get motivated to create the necessary changes to improve performance (p.75). The challenge with the policy is differentiating preventable infections from unpreventable infections at the individual case level, but nonetheless the payment reduction plan will produce immediate future savings as well as     lowering the hospitals overall payments by 8.14% and most importantly   lowering hospital infections.