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Quality of Care Patient Safety

In 1999, the landmark Institute of Medicine study, “To Err is Human,” estimated that as many as 98,000 Americans die every year from preventable medical errors. After more than a decade of work to understand and address these problems, promising examples of better practices are becoming best practices. But despite grand efforts, a high volume of patients are injured in the course of receiving care. There is much more work to be done to prevent unnecessary harm to patients.

Partnership for Patients

Partnership for Patients: Better Care, Lower Costs is a new public-private partnership that will help improve the quality, safety, and affordability of health care for all Americans. The Partnership for Patients brings together leaders of major hospitals, employers, physicians, nurses, and patient advocates along with state and federal governments in a shared effort to make hospital care safer, more reliable, and less costly.

The two goals of this new partnership are to:

  1. Keep patients from getting injured or sicker. By the end of 2013, preventable hospital-acquired conditions would decrease by 40% compared to 2010. Achieving this goal would mean approximately 1.8 million fewer injuries to patients with more than 60,000 lives saved over three years.
  2. Help patients heal without complication. By the end of 2013, preventable complications during a transition from one care setting to another would be decreased so that all hospital readmissions would be reduced by 20% compared to 2010. Achieving this goal would mean more than 1.6 million patients would recover from illness without suffering a preventable complication requiring re-hospitalization within 30 days of discharge.

Achieving these goals will save lives and prevent injuries to millions of Americans, and has the potential to save up to $35 billion dollars across the health care system, including up to $10 billion in Medicare savings over the next three years. Over the next ten years, it could reduce costs to Medicare by about $50 billion and result in billions more in Medicaid savings. This will help put our nation on the path toward a more sustainable health care system.

To find more information about Partnership for Patients, visit HealthCare.gov. Additional information specific to Medicaid is coming soon!

Provider-Preventable Conditions

On June 6, 2011, the Centers for Medicare & Medicaid Services (CMS) published a final rule implementing Provider Preventable Conditions (PPCs) as authorized by section 2702 of the Affordable Care Act. The provisions of this rule prohibit federal payments to states under section 1903 of the Social Security Act for any amounts expended for providing medical assistance for health care-acquired conditions. The final rule incentivizes quality improvement at the provider-level and cost savings for states by requiring states to reduce payments at the occurrence of hospital errors and "never events" in specific health care settings. The final rule became effective July 1, 2011, and CMS provided states with an additional year to meet these new requirements in order to allow states time for the discussion of policy, implementation of required hospital changes, and development of the appropriate systems for reporting.

The final rule includes the umbrella term, "Provider-Preventable Conditions (PPC)," which is defined as two categories, Health Care Acquired Conditions (HCAC) and Other Provider-Preventable Conditions (OPPC).

Highlights from this new rule specific to Medicaid include:

Health Care Acquired Conditions:

  • Apply to Medicaid inpatient hospital settings
  • Are defined as the full list of Medicare HCAC, except for Deep Vein Thrombosis/Pulmonary Embolism following total knee replacement or hip replacement in pediatric and obstetric patients, as the minimum requirements for states' PPC non-payment programs

See the full HCAC list on the Provider Preventable Conditions page.

Other Provider-Preventable Conditions:

  • Apply broadly to Medicaid inpatient and outpatient health care settings where these events may occur
  • Are defined to include, at a minimum, three Medicare serious reportable events related to surgical or other invasive procedures
  • Allow states to expand to settings other than inpatient hospitals with CMS approval by nature of identifying events that occur in other settings
  • Allow states to expand the conditions identified for non-payment with CMS approval, based on criteria set forth in the final regulation

See the full OPPS list on the Provider Preventable Conditions page.

This new rule is significant to improving care for individuals eligible for Medicaid, and also supports the Partnership for Patients initiative.

The Provider Preventable Conditions page contains basic information about the final rule requirements, state plan amendment (SPA) pre-prints and instructions, as well as a Frequently Asked Questions page which includes program-specific questions that will help states craft their PPC policies and meet the State plan requirements. For those states which have not yet submitted the required SPA, CMS staff remains available for direct technical assistance.

Effective October 1, 2012 - Additions to Medicaid Health Care Acquired Conditions

Section 2702(a) of the Affordable Care Act established the framework for application of Medicare prohibitions on payment for health care acquired conditions to the Medicaid program. Specifically, health care acquired conditions are defined as a medical condition for which an individual was diagnosed that could be identified by a secondary diagnostic code described in section 1886(d)(4)(D)(iv) with two new preventable hospital-acquired conditions:

  1. Surgical Site Infection (SSI) Following Cardiac Implantable Electronic Device (CIED) procedures (this is a sub hospital acquired condition within the SSI hospital acquired condition category)
  2. Iatrogenic Pneumothorax with Venous Catheterization

These conditions are effective for discharges occurring on or after October 1, 2012.

Medicaid and CHIP Patient Safety Quality Measures

Patient safety and care transition measures are identified as part of the Centers for Medicare and Medicaid Services (CMS) voluntary, quality measurement reporting program for Medicaid and CHIP state agencies. These measures are part of two core quality measurement sets established by Children's Health Insurance Program Reauthorization Act (CHIPRA) and the Affordable Care Act (ACA). States that are interested can collect the following patient-safety-related measures:

Please view the Performance Measurement page for more information about the initial core set measures for children and adults.

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