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Hospital charges: what retail looks like

Plus, targeted C. diff screening

June 2013

Published in the June 2013 issue of Today’s Hospitalist

Hospital charges: what retail looks like

THE CENTERS FOR MEDICARE AND MEDICAID SERVICE (CMS) last month released a bombshell, publishing the amounts that 3,300 hospitals across the country charged Medicare in 2011 for the 100 most common procedures and treatments. Those data revealed an extraordinary level of variability, with some hospitals charging Medicare 300% more for the same DRG as another hospital in the same city.

According to New York Times coverage, for instance, one Dallas hospital charged Medicare less than $15,000 to treat simple pneumonia, while another hospital in Dallas charged more than $38,000. The CMS actually pays about $9,000 for that DRG, while private insurers negotiate rates at about 30% above Medicare.

The published data reveal that some hospitals charge Medicare 20 times more than the CMS actually reimburses. The article pointed out, however, that patients with no insurance are often charged the full amount. Using the charge data, the Washington Post created an interactive feature to compare average charges in different states to national averages.

Targeted C. diff testing may contain infection

A RECENT STUDY found that screening patients on admission who have one of three risk factors can help hospitals identify C. diff carriers. That may be an important consideration, researchers said, for hospitals battling high infection rates.

The study was published in the May issue of the American Journal of Infection Control. The authors screened asymptomatic patients admitted to a tertiary center in Minnesota who had one of three risk factors: recent hospitalization, chronic dialysis or corticosteroid use. They found that
10% of those patients were indeed colonized. Of the three risk factors, recent hospitalization was the most prevalent.

While screening patients with one of each of the three risk factors would identify 74% of C. diff carriers, researchers found that testing only those patients who had been recently hospitalized would identify 65% of carriers.

The authors noted that targeted screening wouldn’t be practical for all hospitals, but it might be a strategy that hospitals with high C. diff infection rates should consider when they need to expand infection surveillance.

Where are all the ACE units?

STUDIES PUBLISHED IN APRIL in JAMA Internal Medicine found that acute care of the elderly (ACE) units save hospitals money and deliver better outcomes in terms of fewer readmissions and better patient function. So if ACE units work so well, why are there only 200 of them in the country?

That’s the question posed in a HealthLeaders article, which points out that ACE units have been around for 20 years but are in very short supply. There may be very few ACE units because they don’t make much money and because they are complex and rely on coordinated teamwork.

In addition, sources quoted in HealthLeaders say that any intervention that cuts down on readmissions and nursing-home placements isn’t rewarded in a fee-for-service environment.

Experts noted that they expect the number of ACE units to grow with new payment incentives and penalties. They also predicted that a growing number of ACE units will likely lead to some form of accreditation.

The high cost of outdated technology

HOSPITAL BOTTOM LINES and physician productivity are taking a hit because of outdated communication technology being used in hospitals.

That’s according to a new report from Ponemon Institute, a data security research firm based in Traverse City, Mich. The report found that outdated communication technology for all U.S. hospitals costs those hospitals $8.3 billion in aggregate a year.

The report noted that the use of pagers and other antiquated technology leads clinicians to waste 45 minutes per day, costing each hospital nearly $1 million a year. The report also pointed out that communication problems due to outdated technology lead to delayed discharges, which cost each hospital an additional $550,000 per year in missed revenue.

Coverage of the report in Healthcare Informatics said results were based on a survey of nearly 600 clinicians. Survey respondents identified pagers as their biggest problem, followed by a lack of wireless capability in hospitals and clinicians’ inability to text message each other.

PQRS: time to sign on

TO AVOID A 1.5% PENALTY on their Medicare payments in 2015, doctors need to submit data on at least one quality measure code this year to the physician quality reporting system (PQRS). The PQRS program is maintained by the Centers for Medicare and Medicaid Services (CMS).

But according to coverage in American Medical News, participation in the program remains low. In 2011, more than 205,000 physicians reported quality data to the program, and many of them received bonuses. While that represented a substantial increase over the number of doctors who participated in 2008 when the program began, it meant that only 32% of all doctors who were eligible were choosing to participate.

The article noted that Medicare is stepping up outreach programs to doctors. And in 2014, the CMS may begin to accept quality data submitted by physicians to regional or specialty-specific registries or performance programs as meeting PQRS participation requirements.