CONTENTS:
NEWS FEATURE
NEWS AND ANNOUNCEMENTS
NEWS FEATURE
CMS Passes New Rules Limiting Reimbursement
On August 1, 2007, the Centers for Medicare and Medicaid Services (CMS) released the inpatient prospective payment system (PPS) final rule for fiscal year (FY) 2008. The policies and payment rates included in this rule became effective October 1, 2007.
Several of the rule's key provisions include re-design of the DRG system over a two-year period, which begins with a 50/50 payment blend in (FY) 2008 and will be fully implemented by 2009. There will be 745 new Medicare Severity DRGs (MS-DRGs) to replace the current 538 DRGs. The rule also revises the "complications or comorbidity list". The re-classification will create up to three tiers of payment for each diagnosis, based on the presence of a major complication or comorbidity; a minor complication or comorbidity, or no complication or comorbidity. CMS will continue its three-year transition to cost-based relative risks with two thirds of the (FY) 2008 weight based on costs and one third based on charges.
The rule also adds one quality outcome measure for reporting "Pneumonia, 30-day mortality" to make a total of 28 measures by (FY) 2009. Hospitals that submit data on the 27 quality measures will receive a 3.3 percent market basket increase, while those hospitals not submitting data will receive a 1.3 percent update. CMS did not finalize the other proposed measures that had not been received from National Quality Forum (NQF) in an endorsement.
CMS expects the following measures to be approved this fall, and, if so, will adopt them in the final outpatient PPS rule for implementation in 2009: Cardiac surgery patients with controlled 6AM post-op serum glucose; surgery patients with appropriate hair removal; surgery patients on beta-blocker during peri-operative period.
The rule adopts eight conditions including three serious preventable events for which CMS will not provide higher payments if the selected events occur while a patient is under the care of the hospital. The change will take effect (FY) 2009 and will include objects left in surgery, air embolism, blood incompatibility, falls, pressure ulcers, and 3 healthcare associated infections: catheter associated urinary tract infections, vascular catheter associated infections, mediastinitis after coronary artery bypass graft, or these infections must be proven to be present on admission (POA) for CMS reimbursement.
The final rule was published in the August 22 Federal Register, available
at:
http://a257.g.akamaitech.net/7/257/2422/01jan20071800/edocket.access.gpo.gov/2007/pdf/07-3820.pdf
Ref: The American Hospital Association, Special Bulletin, August 2007.
QUESTION OF THE MONTH
Pregnant Women and Varicella Policy
Q: During the past year our hospital has received requests from our local health department to have a policy for pregnant women exposed to Varicella. Our hospital has questions about the recommendations that all staff, contracted employees, and volunteers who work in the HCF have immunity or have the Varicella vaccine. Also, is the ACIP (Advisory Committee on Immunization Practices) advising to no longer accept a verbal history of Varicella disease? Should Occupational Health test all HCWs with a negative Varicella history?
A: In November 2006, CDC advised all Health Departments in the U.S. to prepare themselves and their community, including working with the Obstetricians and hospitals, in a joint effort to complete a recommended list of activities most likely resulting in the prevention of Varicella in pregnant women. The need for this policy became a mandate for health departments because of the discontinuation of the production of Varicella Immune Globulin (V2IG) in the U.S. Dr. Joe Holiday, chief of the Women's Health Branch is overseeing the review of every NC local Health Department's (LHD) Varicella Exposure for Pregnant Women policy. One recommended activity is that LHDs assure that all staff, contract employees, and volunteers who work in hospitals, private physician offices and local health departments have immunity or have had the vaccine. In addition, the ACIP Provisional Recommendations for Prevention of Varicella, 2006, has recommended no longer accepting just a verbal history of chickenpox disease from HCWs. However, for hospitals the need to require either a proof of a serologic test or immunization may be based on risk of exposure (i.e., direct face to face contact time with pregnant women). Hospitals have no set rules for having to review all existing HCWs that have self-reported negative Chicken Pox histories, unless working directly with pregnant women (i.e., ED, OB, PEDS nursery units). But healthcare facilities should consider whether to begin requiring either serologic evidence or proof of immunization for Varicella from all HCWs. ICPs should contact the Women's Health Program at their local Health Department for more information on their county Varicella policy and develop a hospital policy.
REGULATORY/LEGISLATIVE
NC Communicable Disease Rule Revisions, Including HIV Testing
A brief index of changes approved by the Commission for Public Health and the Rules Review Commission follows. The rule changes became effective November 1, 2007.
Provided by Dr. Jeff Engel, State Epidemiologist, NC Communicable Disease Section.
COURSES FOR THE INFECTION CONTROL PROFESSIONAL
IHI Regional Workshops - IMPLEMENT THE IHI VAP AND CLABSI BUNDLES
(registration currently underway -
http://www.unc.edu/depts/spice/IHI.html):
SPICE Infection Control Spring 2008 Courses, Friday Center, Chapel Hill, NC
NEWS AND ANNOUNCEMENTS
CMS revises interpretive guidelines for infection control regulations
(reprinted from Infection Control Monitor, December 7, 2007:
http://www.hcpro.com/ezine/1530/12062007)
While the regulations themselves haven't changed, the Centers for Medicare & Medicaid Services (CMS) has issued revised interpretive guidelines for the hospital regulations for infection control.
In a November 21 letter to state survey agency directors, CMS announced the revisions to the interpretive guidelines, which are effective immediately. "Changing infectious disease threats, as well as new mechanisms to confront these threats, have emerged in recent years. As a result, it is necessary to update these guidelines to better reflect current conditions within hospitals as well as contemporary infection control standards of practice," CMS said. For example, the new guidelines speak to special challenges in infection control that include MDROs, ambulatory care settings, communicable disease outbreaks, and bioterrorism.
The interpretive guidelines discuss the requirements for the infection control Conditions of Participation, as well as the procedures for surveyors to use to determine hospital compliance. The guidelines also contain discussion and examples of practices that hospitals are encouraged to adopt, but which are not necessarily required by regulation, CMS said.
SPICE CBIC course passes NC Board of Nursing (BON) Continued Competency Requirements
The NC Board of Nursing (BON) passed new requirements for renewal of the RN license which became effective July 1, 2006. One option to fulfill this "Continued Competency" requirement is National Certification or re-Certification related to the nurses' practice role by a national credentialing body recognized by the Board. A special thank you to Mary Faint, ICP at Annie Penn Hospital, for confirming that the APIC Certification Exam fulfills this option.
New CDC Fact Sheet on MRSA in Schools
A new fact sheet has been added to the CDC Web site to assist with questions about MRSA in school settings. CDC, along with parents and school officials, wants to do everything possible to protect students from MRSA skin infections. These are commonly asked questions that will help parents and school officials prevent the spread of MRSA in schools. Here are some of the featured questions:
The following 3 News Items are taken from the Infection Control Monitor, November 30, 2007:
A Swiss drug manufacturer has agreed to put a stronger warning label on its flu drug Tamiflu, reported the Associated Press (AP). The company, Roche Holding AG, accepted a recommendation made Tuesday by a U.S. Food and Drug Administration (FDA) panel that the label should say that several patients have died as result of abnormal behaviors. A company spokesman said there is no connection between Tamiflu and reported cases of delirium and hallucinations. However, she said, all patients with full-blown flu should be warned that the illness itself poses a risk of psychiatric problems, not just for those taking Tamiflu, the AP reported. The FDA said nearly 600 cases of psychiatric problems have been reported in Tamiflu patients, with 75 percent of them coming from Japan, where five children have died after falling from windows or balconies or running into traffic. Several governments have stockpiled Tamiflu in case avian flu mutates to spark a human flu pandemic.
The Joint Commission (formerly JCAHO) plans to implement revised infection prevent and control standards in January 2009.
The accreditor said it plans to begin conducting mock surveys using the new standards in early 2008 and plans to issue the final revised standards to healthcare organizations in mid-year, reported the November issue of Joint Commission Online.
The Joint Commission's Standards and Survey Procedures Committee approved the revised standards earlier this year. New standards will take effect for the hospital, ambulatory care, critical access hospital, home care, and office-based surgery programs.
Housekeeping staff members are a critical resource when it comes to reducing the transmission of organisms such as Clostridium difficile and vancomycin-resistant enterococcus (VRE). But when researchers at the Louis Stokes Cleveland Veterans Affairs Medical Center examined the effectiveness of their housekeeping staff's disinfection efforts, they were disappointed. After meeting with the housekeeping staff, researchers made the following changes:
The following 2 reports are taken from the Morbidity and Mortality Weekly Report:
During June--July 2006, a total of 41 culture-confirmed Salmonella
serotype Oranienburg infections were diagnosed in persons in 10
northeastern U.S. states and one Canadian province. This report describes
the epidemiologic, environmental, and laboratory investigations of this
outbreak by federal, state, and local health agencies; the Food and Drug
Administration (FDA); and the Canadian Food Inspection Agency. The results
of the investigations determined that illness was associated with eating
fruit salad in health-care facilities. Although the fruit salads were
produced by one processing plant, the source of contamination was not
determined. This outbreak highlights the importance of laboratory-based
surveillance of Salmonella, including molecular subtyping, and
timely communication of public health information. The complete report
can be found here:
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5639a3.htm
In April 2007, GlaxoSmithKline Vaccine Division (GlaxoSmithKline Biologicals, King of Prussia, Pennsylvania) received approval from the Food and Drug Administration (FDA) for an alternate schedule for Twinrix, a combined hepatitis A and hepatitis B vaccine. Twinrix was first licensed by FDA in 2001 on a 3-dose schedule (0, 1, and 6 months) for vaccination of persons aged >18 years. Using the newly licensed, alternate 4-dose schedule, Twinrix doses can be administered at 0, 7, and 21-30 days, followed by a dose at 12 months. The announcement can be found here: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5640a5.htm
CDC - New sharps pamphlet for worker training
A new pamphlet being released by the CDC - Sharps Safety for Healthcare
Personnel, describes healthcare worker risk, how and when injuries occur,
how sharps safety devices reduce injuries, and the importance of
developing a "culture of safety" for sharps injury prevention. This and
other sharps injury prevention brochures are publicly accessible on the
Safety Institute Web site
(
http://www.premierinc.com/quality-safety/tools-services/safety/topics/needlestick/)
to assist frontline workers in selecting safety devices to evaluate for
their institutions. The Web site also contains links to national lists of
sharps safety products. A new addition to the available tools is the
needlestick prevention booklet for non-acute care.
Download the pamphlet here:
http://www.premierinc.com/quality-safety/tools-services/safety/topics/needlestick/downloads/cdc-sharps-brochure-10-01-07.pdf
Source: Safety Share newsletter, Premier, Inc.
Contributors to Report of the Month: Karen K. Hoffmann, RN, MS, CIC; William A. Rutala, PhD, MPH; David J. Weber, MD, MPH; Eva P. Clontz, MEd, Debby Pyatt, BA
Report of the Month is also available on the home page of the Statewide Program for Infection Control and Epidemiology at http://www.unc.edu/depts/spice/. The Statewide Program for Infection Control and Epidemiology (SPICE) is funded by the General Assembly of North Carolina to serve the State. The SPICE is not a regulatory agency but provides education and consultation to North Carolina healthcare facilities.
Sent December 2007
Copyright 2007 Statewide Infection Control Program