Georgia Hospital Association - CARE

Situation

Beginning October 2008, Medicare will lower hospital reimbursement if the following conditions were acquired during hospital stay– pressure ulcers, catheter-associated urinary tract infections, vascular catheter associated infections, falls, mediastinitis post CABG, blood incompatibility, air embolism, retained objects following surgery. In addition, reports indicate that many commercial insurance plans and Medicaid are expected to follow Medicare’s lead.

Hospitals, therefore, can expect to suffer severe financial hardships unless they can limit or eliminate these hospital acquired conditions.

For example, the costs associated with pressure ulcers can be as high as $811 per day for a stage IV ulcer, and total treatment costs can reach as $73,000 per occurrence.

To limit the financial hardship of this rule and to improve patient safety, hospitals will need good information and data driven programs to improve patient care and their bottom line.

Solution

The Georgia Hospital Association’s CARE Program is designed to provide hospitals with decision support systems and tools to improve quality of care, operational efficiency, financial stability and to facilitate public reporting.

Products include CARE2, CARE CORE, HIGH RISK and MEDEVAL Programs. Using the High Risk Module’s Patient Safety Indicators (PSIs) feature, hospitals can identify opportunities and implement solutions to improve patient care and financial stability. For example, data on pressure ulcers can be reported and also compared to the 27 benchmarks including bed size, region, urban/ rural, teaching status, and CAH.

The High Risk Module – as with all CARE products allows drill downs by clinical department, DRGs, APS-DRG, physician and patient. In the case of pressure ulcers, hospitals can determine the number of cases, look at admission source and chart trends to uncover the causes.

A key to successfully managing reimbursement will be the hospital’s ability to document the presence on admission on some of these conditions. Organizations can get a jump start by looking at their data for source of admission and other variables in relation to the hospital acquired conditions to see if there are trends prior to the date that payments will be effective. Tools can be developed to alert staff on key points to look for on admission for documentation.

One hospital recently learned through review of their data that the CMS reported mortality rates were not a true reflection of their data. Using CARE’s data analysis tools, they discovered that due to under coding of some co-morbid conditions their severity adjusted mortality rates were inaccurate.

Good data is the foundation for successful programs to address and monitor patient care to provide the best clinical and financial outcomes possible.

Better Health Lower Costs

Reductions in Complications, Length of stay, and Costs.
Georgia hospitals will be able to improve patient safety and quality of care, and achieve financial stability by using CARE’s data driven decision support systems. For one, monitoring and tracking nosocomial pressure ulcers can result in $1.6 million in savings to consumers.
Improved Outcomes, Patients satisfaction, and Reimbursement for financial stability