American Association for Clinical Chemistry
Better health through laboratory medicine
May 2011 Clinical Laboratory News: Regulatory Profiles

CMS Publishes Hospital-Acquired Infection Data

For the first time, consumers can see how often hospitals report hospital-acquired infections via CMS’s Hospital Compare website. The Centers for Medicare and Medicaid Services (CMS) published the data despite strong objections from the American Hospital Association (AHA) that the data is inaccurate.

Collected on Medicare fee-for-service patients between October 2008 and June 2010, the data disclose infections per 1,000 discharges. However, the numbers are not adjusted for hospitals’ patient populations or case-mix—one point of contention with AHA.

CMS noted that although not every infection represents a medical error, the rates provide “important clues” about the state of patient safety in America’s hospitals. Rates for infection were relatively common, with about 45% of hospitals reporting at least one blood or urinary tract infection developed during the hospital stay. Nationwide, a blood or urinary tract infection was reported once for every 3,300 discharges. Rates were lowest for instances of blood incompatibility, which was reported by less than 1% of hospitals and occurred once for every 1,000,000 discharges.

The data are available from the CMS website.

Rules for Accountable Care Organizations Released

The Department of Health and Human Services (HHS) released long-awaited proposed rules to help healthcare providers form Accountable Care Organizations (ACO) that coordinate care for Medicare patients. First sketched out in the health reform law, ACOs give financial incentives for providers, including labs, to work together to treat an individual patient across care settings. The Medicare Shared Savings Program will reward ACOs that lower healthcare costs while meeting performance standards on quality of care and putting patients first. Patient and provider participation in an ACO is voluntary.

Under the proposal, ACOs—teams of doctors, hospitals, and other providers and suppliers working together—would coordinate and improve care for patients covered by original Medicare plans. To share in savings, ACOs must meet quality standards in five areas: patient/caregiver care experiences; care coordination; patient safety; preventive health; and at-risk population/frail elderly health. If an ACO saves money through better coordination, for example, by improving access to primary care so that patients can avoid a trip to the emergency room, the ACO can share in those savings with Medicare.  The new program will be established on January 1, 2012.

HHS also announced it will hold a series of open-door forums during the comment period to help the public understand what the Centers for Medicare & Medicaid Services, the agency administering the ACO program, is proposing to do and to ensure that the public understands how to participate in the formal comment process.
The rule is posted online, and HHS is accepting comments on the rule until June 6.

Comments may be submitted online.

Government Reports Target Healthcare to Trim Deficit

Recent reports from the Congressional Budget Office (CBO) and the Government Accountability Office (GAO) both lean on scientific research and healthcare as potential targets for cutting the deficit.

The CBO’s report, “Reducing the Deficit: Spending and Revenue Options,” covers 105 policy suggestions to Congress, including: reducing NIH spending by up to $43 billion; cutting the federal share of Medicaid from 50% to 45%; adopting across-the-board reductions in Medicare payments to providers in areas where Medicare spending per beneficiary is 10% higher than the national average; and establishing uniform co-payments for all Medicare services—including clinical laboratory tests—once an annual deductible is met.

Similarly, GAO’s report, “Opportunities to Reduce Potential Duplication in Government Programs, Save Tax Dollars, and Enhance Revenues,” also looked at healthcare. The report recommends elimination of duplicated or fragmented programs, including: overlapping Department of Defense (DoD) and Veterans Administration (VA) electronic health records; separate purchases of drugs by the DoD and VA; and the lack of an integrated nationwide public health information system.

GAO also highlighted Medicare and Medicaid as targets for savings. Recommendations include preventing improper Medicaid payments and providing greater oversight of Medicaid supplemental payments.

In response to this report, Senators Orrin Hatch (R-Utah) and Mark Udall (D-Colo.) introduced legislation to create a bipartisan Senate committee to eliminate “wasteful” government programs.

The CBO and GAO reports are available from the CBO website and the GAO website.

National Quality Strategy Focuses on Patient Safety, Care Coordination

Created under the healthcare reform law, the first-ever national quality strategy is intended to guide local, state, and national efforts to improve quality of care, and includes goals familiar to labs, such as patient safety. It also underscores evidence-based medicine and new payment models.

Undergirding the strategy are three core goals: make care more patient-centered, reliable, accessible, and safe; support proven interventions to address behavioral, social, and environmental determinants of health; and reduce the cost of care for individuals, families, employers, and government. To help achieve these aims, the strategy also establishes six priorities to help focus efforts by public and private partners. Those priorities are: making care safer by reducing harm caused in the delivery of care; ensuring that each person and family are engaged as partners in their care; promoting effective communication and coordination of care; promoting the most effective prevention and treatment practices for the leading causes of mortality, starting with cardiovascular disease; working with communities to promote wide use of best practices to enable healthy living; and making care more affordable by developing and spreading new healthcare delivery models.

The Department of Health and Human Services developed the strategy both through evidence-based research and in collaboration with federal and state agencies, local communities, provider organizations, clinicians, patients, businesses, employers, and payers.

The strategy is available online.