Federal Reporting

 

Costs & Reimbursement: In addition, VAP prolongs time spent on the ventilator, length of ICU stay, and length of hospital stay after discharge from the ICU.(1)  An estimate of the direct cost of excess hospital stay due to VAP is $40,000 per patient.(2)

 

Important Implementation Dates

  • October 1, 2007
    All Inpatient Prospective Payment System (IPPS) Hospitals were required to submit Present on Admission (POA) Indicator information for all primary and secondary diagnoses.
  • January 1, 2008
    CMS began processing POA Indicator data and provided feedback to IPPS hospitals on reporting errors. During the period of January 1, – March 31, 2008 hospitals were educated on reporting errors and were NOT subject to returned claims.
  • April 1, 2008
    Claims that are submitted for payment that do not contain proper reporting of the POA Indicator will be returned.

 

State Reporting

 

The following is a summary of state activity and legislation regarding the disclosure by hospitals of their hospital infection rates.

 

As of June 15, 2008:

  • 22 states have laws requiring public reporting of infection rates (CO, CT, DE, FL, IL, MD, MN, MO, NJ, NY, NH, OH, OK, OR, PA, SC, TN, TX, VA, VT, WA, WV); >
  • 2 state laws require public reporting of infection information, but not specifically infection rates (CA, RI).
  • 2 state laws require confidential reporting of infection rates to state agencies (NE, NV).
  • 1 state has voluntary law requiring public reporting of infection information (AR);
  • All other states except WY, AZ, MT, ND have considered hospital infection reporting laws, but have not yet passed legislation.
    Click here for further updates.

 

Here is an example of how an individual state is handling their cost reporting.

Pennsylvania Healthcare Cost Council Pennsylvania Healthcare Cost Containment Council is an independent state agency responsible for addressing the problem of escalating health costs, ensuring the quality of healthcare, and increasing access for all citizens regardless of ability to pay. This website is a good source of data (2005) regarding number of cases of HAI, the average length of stay, and related costs.

 

  • The average payment for a hospitalization in which a patient acquired an infection was $53,915, while the payment when a hospital-acquired infection was not present averaged $8,311. The differences in payment varied by the condition that brought a patient to the hospital.

 

Reporting Statistics:

Infection statistics should be documented and retained. One method of reporting and recording this event is shown on the IHI website:

 

  • Institute for Healthcare Improvement - VAP Rate per 1000 Ventilator Days
  • The ventilator-associated pneumonia (VAP) rate is defined as the number of ventilator-associated pneumonias per 1,000 ventilator days. In this case, for a particular time period, we are interested in the total number of cases of ventilator-associated pneumonia in the ICU. For example, if in February there were 12 cases of VAP, the number of cases would be 12 for that month.
  • To understand that number as a proportion of the total number of days that patients were on ventilators, here is an example: if 25 patients were ventilated during the month and, for purposes of example, each was on mechanical ventilation for 3 days, the number of ventilator days would be 25 x 3 = 75 ventilator days for February. The Ventilator-Associated Pneumonia Rate per 1,000 Ventilator Days then would be 12/75 x 1000 = 160.

 

References:

(1) Rello J, Ollendorf D.A., Oster G., et al. VAP Outcomes Scientific Advisory Group. Epidemiology and outcomes of ventilator-associated pneumonia in a large U.S. database. Chest. 2002 Dec;122(6):2115-2121.

 

(2) Tablan O.C., Anderson L.J., Besser R., et al. CDC Healthcare Infection Control Practices Advisory Committee. Guidelines for preventing healthcare-associated pneumonia, 2003: Recommendations of CDC and the Healthcare Infection Control Practices Advisory Committee. MMWR Recomm Rep. 2004 Mar 26;53 (RR-3):1-36.



Related Links:

 

Reimbursement Hotline
Questions about reimbursement?

 

To keep up to date with reimbursement issues, we offer a toll-free reimbursement hotline

 

Clinical Foundations

A Patient-Focused Education Program for Respiratory Care Professionals

 

 

 

 

Institute of Healthcare Improvement
5 Million Lives Campaign

The 5 Million Lives Campaign is a voluntary initiative to protect patients from five million incidents of medical harm over the next two years (December 2006 – December 2008).


Other Resources: