And, finally there is the hospital value-based purchasing (VBP) for FY 2015 with its increase to 1.5 percent of base operating DRG payment amounts to all participating hospitals that will go into the "pool," that hospitals can "win back," with delivery of high-quality, cost -care. The total estimated amount available for value-based incentive payments in FY 2015 is approximately $1.4 billion.  The measures that are part of this program can be found on the Centers for Medicare and Medicaid Services Website at http://www.cms.gov/hospital-value-based-purchasing.



DOTmed News: Is it all bad news for hospitals?

JR: For those hospitals that provide high-quality, cost-effective care per the requirements of the Value-Based Purchasing program, there is the opportunity to have more money come back to your institution versus the 1.5 percent of Medicare allowables that the hospital contributed to the pool.

Also, hospitals can institute new and additional clinical protocols and practices such that they are not in the bottom 25% regarding having the highest numbers of HACs that would mean a 1 percent reduction from that program. They can also creative collaborative relationships with other providers in their communities to help support patients in their homes, post an admission, to be more successful under the hospital readmissions program.

DOTmed News: Is there anything else in the 2015 Final IPPS rule or anything else coming down the pipeline, especially concerning imaging, that you think is important for people to know about?
 
JR: We see an enhanced focus in the FY 2015 IPPS rule regarding patient safety and there is a large role for imaging to play in providing better patient care. One of these areas is in regard to vascular access and the insertion of catheters into a patient's body. Three of the hospital acquired conditions that are also part of quality measures in the value-based purchasing program are Iatrogenic Pneumothorax; Central Venous Catheter-related bloodstream infections; and Central Line-Associated Blood Stream Infection (CLABSI) and they can be avoided with the adoption of a protocol that requires ultrasound guidance with all venous access procedures.
 
DOTmed News: In your opinion, what is one area where hospitals could easily focus to improve quality?
 
JR: CMS continues to accept nominations of additional conditions that met the requirements for the HAC program - high volume and high cost.

Iatrogenic Pneumothorax with thoracentesis is a condition in the Medicare acute care, inpatient setting that is both high cost and high volume. In a review of the FY 2011 MedPAR data, Direct Research, LLC found that more than 30,000 iatrogenic pneumothorax were caused by something other than venous catheterization. In addition, a study conducted by the United Biosource Corporation using the Premier Hospital Data Set and published in CHEST in 2013 demonstrated that an iatrogenic pneumothorax caused by a thoracentesis increased a patient's length of stay by 1.4 days and their cost by almost $2,800.

More Voices