* Surgical site infection- Mediastinitis (infection in the chest) after coronary artery bypass graft surgery
* Certain types of falls and trauma

CMS is proposing to expand the list of conditions that need to be reported if present when a patient is first admitted and is seeking public comment on whether they should be added to the list in the final rule to be announced later this year. The list in the proposed rule includes:
* Surgical site infections following certain elective procedures

* Legionnaires' disease (a type of pneumonia caused by a specific bacterium)
* Extreme blood sugar derangement
* Iatrogenic pneumothorax (collapse of the lung)
* Delirium
* Ventilator-associated pneumonia
* Deep vein thrombosis/Pulmonary Embolism (formation/movement of a blood clot)
* Staphylococcus aureus septicemia (bloodstream infection)
* Clostridium difficile associated disease (a bacterium that causes severe diarrhea and more serious intestinal conditions such as colitis)

Beginning October 1, 2008, Medicare will no longer pay the hospital at a higher rate for the original eight conditions or any conditions added to the list in the final rule, if they were acquired during the hospital stay.

The second initiative CMS is proposing is the expansion of the hospital quality measure reporting program, which reduces the amount a hospital is paid if it does not participate in the voluntary reporting of standardized quality measures. These are measures that are publicly reported on Hospital Compare. Hospitals are currently required to report 30 quality measures on their claims for Medicare inpatient services to qualify for a full update to their FY 2009 payment rates. CMS is proposing to add 43 quality measures to the list in order to get the full inflation update for FY 2010, bringing the total number of measures in FY 2009 to 73. The proposed additions include the measures of the following types:

* Surgical Care Improvement Project (SCIP) - 1 new measure
* Hospital readmissions - 3
* Nursing care - 4
* Patient Safety Indicators developed by the Agency for Healthcare Research and Quality (AHRQ) - 5
* Inpatient Quality Indicators developed by the AHRQ - 4
* Venous thromboembolism measures (VTEs) - 6
* Stroke measures (STK) - 5
* Cardiac surgery measures -15

In proposing to require hospitals to report on readmissions, CMS notes that almost 18 percent of Medicare patients are readmitted to the hospital within 30 days of discharge, potentially exposing the patients and their families to significant additional suffering. Taken together with the patient satisfaction information recently reported on Hospital Compare web site that shows the effectiveness of nurse and physician communication with the patient, including discharge planning, the building blocks for monitoring and improving the entire episode of care will be available. The impact on taxpayers is also significant. According to the Medicare Payment Advisory Commission (MedPAC), readmissions cost the program $15 billion annually, with $12 billion of those costs potentially preventable.

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