The quality of care cerberus: payments, public reporting, and enforcement

To achieve this transformation, the government has employed a three-pronged approach: (1) changing payment policy so payment is made only for high-quality care, not for merely rendering services; (2) making healthcare providers' quality transparent through public reporting; and (3) increasing e...

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Bibliographic Details
Published in:	The Health lawyer Vol. 20; no. 2; p. 1
Main Authors:	Wagonhurst, Cheryl L, Anderson, Janice A, Lacktman, Nathaniel M
Format:	Magazine Article
Language:	English
Published:	Chicago American Bar Association 01-12-2007
Subjects:	Boards of directors Civil actions Fraud Health care policy Hospitals Incentives Initiatives Laws, regulations and rules Medical care Medical care, Cost of Pay for performance Payments Peer review Quality management Quality of care Regulatory compliance Risk
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Summary:	To achieve this transformation, the government has employed a three-pronged approach: (1) changing payment policy so payment is made only for high-quality care, not for merely rendering services; (2) making healthcare providers' quality transparent through public reporting; and (3) increasing enforcement of quality through criminal and civil actions under the False Claims Act (FCA).2 In accordance with that paradigm shift, the Department of Health and Human Services' Office of Inspector General (OIG) and the American Health Lawyers Association (AHLA) issued a September 13, 2007 joint report, Corporate Responsibility and Health Care Quality: A Resource for Health Care Boards of Directors.3 The report urges boards of directors to take serious and immediate efforts to understand their healthcare organization's ability to monitor and provide high-quality care as a core fiduciary obligation. [...] Section 5001 (c) of the Deficit Reduction Act requires hospitals to report certain secondary diagnoses that are present at the time a patient is admitted to the hospital.9 Beginning October 1, 2008, cases with certain hospital acquired conditions, sometimes referred to as never events,10 (e.g., catheter-induced urinary tract infections, falls, certain surgical infections, pressure ulcers, etc.) will not be assigned to a higher paying DiagnosisRelated Group (DRG) unless it was reported that the patient had the condition at the time of admission to the hospital.11 This is an evolving list, and CMS will expand the number of never events.
ISSN:	0736-3443