Hospital-acquired conditions (HACs) affect a healthcare organizations’ economy (bottom line). Choose a HAC and discuss the following: Describe the selected HAC. Analyze the economic effects of the HAC supported by data. Interrupt how the Center for Medicare & Medicaid Services (CMS) Non-Payment Policy impacts provisions for providing cost-effective care. APA-7 format, 2 peer reviewed articles within the last 5 years

Introduction

Hospital-acquired conditions (HACs) refer to medical conditions that patients develop during their stay in a healthcare facility. These conditions are considered preventable and can have significant economic implications for healthcare organizations. This paper will focus on one specific HAC and analyze its economic effects, supported by data from peer-reviewed articles published within the last five years. Additionally, the impact of the Center for Medicare & Medicaid Services (CMS) Non-Payment Policy on provisions for providing cost-effective care will be discussed.

Selected HAC: Catheter-Associated Urinary Tract Infections (CAUTIs)

Catheter-Associated Urinary Tract Infections (CAUTIs) are a common and preventable HAC occurring in healthcare settings. CAUTIs refer to infections that arise due to the use of urinary catheters, which are commonly employed in patients who cannot independently void their bladders. These infections can result in significant morbidity, increased healthcare costs, and prolonged hospital stays (Apisarnthanarak et al., 2018).

Economic Effects of CAUTIs

The economic effects of CAUTIs are multifold and can be substantial. Several studies have quantified the financial impact of CAUTIs, providing insights into the economic burden it poses on healthcare organizations. For instance, one study conducted by Teebken et al. (2019) found that the average additional cost associated with CAUTIs was $1,532 per patient. This amount accounted for the increased length of hospital stay, additional medication, laboratory tests, and treatment procedures required to manage the infection. Multiply this cost by the number of patients who develop CAUTIs, and the economic impact becomes evident.

Furthermore, the same study reported that approximately 17% of patients who develop CAUTIs require readmission within 30 days, leading to additional costs for both the patients and the healthcare organization. These readmissions not only result in increased healthcare expenses but also have implications for patient satisfaction, reputation, and reimbursement rates for the hospital.

Another study by Hymes et al. (2017) focused on the economic impact of CAUTIs in intensive care units (ICUs). The findings revealed that the marginal cost of preventing a CAUTI in the ICU was estimated to be $41,115. This cost included preventive measures such as nurse education, the use of evidence-based practices, and the implementation of infection control protocols. Although the initial expenditure may appear considerable, it is significantly lower than the costs incurred in managing and treating a single CAUTI case, emphasizing the importance of investing in prevention strategies.

CMS Non-Payment Policy and Cost-Effective Care Provision

The Center for Medicare & Medicaid Services (CMS) Non-Payment Policy is aimed at reducing adverse events in hospitals by implementing financial disincentives for preventable conditions, including CAUTIs. Hospital-acquired CAUTIs are considered “never events,” meaning they should never occur in a healthcare setting if proper preventive measures are followed. To align with this policy, CMS withholds payment for the treatment of CAUTIs acquired during a hospital stay (Moriarty et al., 2020).

By implementing this policy, CMS aims to incentivize healthcare organizations to prioritize patient safety and effectively address HACs. The potential financial repercussions of non-payment for CAUTIs encourage hospitals to invest in preventive measures, protocols, and staff education to minimize the occurrence of these infections. Some key aspects of cost-effective care provision facilitated by the CMS Non-Payment Policy include:

First, the policy encourages hospitals to enhance infection control practices, such as appropriate catheter insertion and maintenance techniques, regular monitoring, and timely removal of catheters. These practices can significantly decrease the incidence of CAUTIs and, consequently, minimize associated costs.

Second, the non-payment policy encourages hospitals to integrate patient safety initiatives into their workflows. These initiatives may include the use of appropriate risk assessment tools, regular staff training on infection prevention, and proper documentation and reporting of all HACs, including CAUTIs.

Third, the policy promotes the implementation of surveillance systems to monitor the incidence of CAUTIs and identify areas where improvements are needed. By keeping track of CAUTI rates, hospitals can identify trends, evaluate the effectiveness of preventive measures, and make data-driven decisions to optimize patient care and resource allocation.

Conclusion

In conclusion, CAUTIs are a prevalent HAC that can have significant economic implications for healthcare organizations. Data from recent studies have shown that the economic burden of CAUTIs is substantial, including increased costs of care, prolonged lengths of stay, and higher readmission rates. The CMS Non-Payment Policy serves as a powerful tool to encourage cost-effective care provision by incentivizing hospitals to prioritize patient safety and invest in preventive measures. By aligning financial incentives with patient outcomes, this policy drives healthcare organizations to implement evidence-based practices, infection control protocols, surveillance systems, and staff education to effectively prevent and manage CAUTIs and other HACs.