Value-Based Purchasing: Non-Payment for Hospital-Acquired Conditions

Author:

Kathy A. Jankowski, Walt Zywiak and Jane Metzger

An important operative in healthcare reform is VBP (value-based purchasing), which is pressuring hospitals to improve and report, and encouraging consumers to purchase healthcare based on outcomes quality; and a current VBP focal point is the CMS HAC payment adjustment provision, which denies claims payment upgrades for selected HACs (hospital-acquired conditions). For discharges on and after October 1, 2008, the provision requires CMS to adjust Medicare hospital claim payments when specified HACs are not POA (present on admission). This white paper discusses claims POA reporting requirements, payment adjustment criteria, and mechanics associated with HAC payment adjustments. It also identifies and discusses other payer responses, hospital workflows affected, how hospitals are responding, and how both HAC payment adjustment demands and responses are related to overall VBP and never event management initiatives.

Download "Value-Based Purchasing: Non-Payment for Hospital-Acquired Conditions" (PDF, 138KB)

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