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From Health Law Daily, April 23, 2015

Weekend hospital admissions more likely to be subject to medical errors

By Kayla R. Bryant, J.D.

Patients admitted to the hospital on the weekends are 25 percent more likely to develop hospital-acquired conditions than those admitted on weekdays, after adjusting for several different factors, according to a report issued by the BMJ. Treatment for this group of 14 conditions, termed “never events,” does not qualify for reimbursement from federal health care programs, as the conditions are the result of “serious, costly, and preventable medical errors,” according to CMS. However, some in the industry are of the opinion that not all hospital-acquired conditions are preventable and that CMS’ policy negatively impacts patient care.

Study. This study involved data from the Nationwide Inpatient Sample assembled by the Agency for Healthcare Research and Quality, the largest inpatient database in the U.S., which is representative of all types of payers and captures 20 percent of all hospital discharges. The study included all patients admitted between 2002 and 2010. Each discharge was considered an independent event, as unique patient identifiers were not available. The frequency of individual hospital-acquired conditions was tabulated and compared to inpatient charges and prolonged stays.

Results. Out of 351 million inpatient admissions during the studied time period, 4.1 percent involved at least one hospital-acquired condition. According to the report, 5.7 percent of these occurrences happened to patients who were weekend admissions, as opposed to 3.7 percent who were admitted during the week. Weekday admissions occurred mostly for routine problems, and weekend admissions largely stemmed from the emergency department. From 2002 to 2010, hospital-acquired conditions increased by 1.6 percent. The presence of one of these conditions was associated with both higher charges and prolonged hospital stays.

Discussion. Although a 17 percent reduction in hospital-acquired conditions has resulted in savings of approximately $12 billion, an estimated $9.3 billion still goes to treating potentially preventable medical errors. The decreased staff volume and level of medical expertise available during the weekends are possible factors contributing to the increase in hospital-acquired conditions among patients admitted on weekends. On weekends, diagnostic testing and operative intervention are allocated fewer resources, and certain procedures are often delayed longer during these days. This trend is not limited only to the U.S., as studies from other countries have shown that the mortality rate in hospitals increases for weekend admissions.

The report indicated that additional resources and attention from health care administration are needed to increase the quality of care provided during the weekends. These conditions are generally attributed to medical errors, so increased training, plans for handling reduced staffing, and strong adherence to safety may help prevent these conditions. An estimated 20 percent of hospital-acquired infections are deemed to be preventable if proper training procedures are implemented.

Reduction program. Hospitals now have more of an incentive to prevent these conditions. Section 3008 of the Patient Protection and Affordable Care Act (ACA) (P.L. 111-148) implemented the Hospital Acquired Condition Reduction Program. Hospitals are scored according to performance. Those hospitals that rank in the quartile with the highest total scores receive reduced payments from CMS beginning in fiscal year (FY) 2015.

Companies: The BMJ

MainStory: TopStory ReimbursementNews CMSNews AuditNews IPPSNews MedicaidPaymentNews PartANews RiskNews

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