Among the other provisions drawing the focus of hospital advocates are new data requirements for patient records.


June 14—Hospitals will be required to undertake about $1 billion in new spending each year on infection control and antibiotic limitations under a proposed rule issued this week by the Centers for Medicare & Medicaid Services (CMS).

The proposed rule would update and revise the conditions of participation for 4,900 hospitals and 1,300 critical access hospitals (CAHs) in Medicare and Medicaid. Hospitals’ costs to implement the new requirements would range from $800 million to 1.3 billion each year and be “largely, but not entirely, offset by savings,” the rule stated.

The costliest provisions were those requiring hospital-wide infection prevention and control for the surveillance, prevention, and control of healthcare-associated infections and other infectious diseases; and antibiotic stewardship programs for the appropriate use of antibiotics. The estimated annual costs of those programs ranged from $700 million to $1.2 billion  for hospitals and $45 million for CAHs.

Hospitals’ general reluctance to voluntarily establish such programs indicated that the cost of creating and maintaining them would be “at least $1 billion,” according to the rule. The annual labor costs alone for the infection-control and antibiotic-use provisions were estimated at $297 million, and the rule noted that may be a low estimate.

The infection-control and antibiotic-use requirements were expected to provide the bulk of the estimated $1 billion in annual savings, although CMS noted that an unknown share of those savings would go to payers and not to hospitals.

The estimated savings specifically included $520 million for the 2,940 hospitals that lack an antibiotic-use control program, according to CMS.

Specific costs included an estimated $20 million for hospitals to appoint an “infection preventionist” or infection control professional.

The rule cited a range of research to support its cost estimates and justified the new requirements by citing a 2013 literature review that concluded at least 210,000 deaths each year were associated with preventable harms in hospitals.

“The evidence indicates that patients are being harmed every day in hospitals across the country and that more work is needed to reduce this harm,” CMS wrote in the rule.

The rate of hospital-acquired conditions (HACs), which had fallen 17 percent from 2010 through 2013, was unchanged in 2014, according to a report released in December 2015 by the U.S. Department of Health and Human Services.

Medicare cut payments by 1 percent for hospitals with the highest frequency of HACs as part of the latest in a series of CMS programs aimed at reducing the HAC rate. The Hospital-Acquired Condition Reduction Program, which took effect Oct. 1, 2014, penalized 721 hospitals in FY15 for excess rates of certain patient injuries, such as central line-associated bloodstream infections, catheter-associated urinary tract infections, and pressure ulcers, according to published reports.

Hospital groups were generally supportive of the new requirements.

“We are reviewing the details of the rule, but the emphasis on good infection control and antibiotic stewardship is consistent with the important work hospitals are doing to reduce infections and preserve the effectiveness of our current antibiotics,” Nancy Foster, vice president of quality and patient safety policy at the American Hospital Association, wrote to HFMA News. “We join CMS in recognizing the importance of these programs and are always looking to make them more effective.”

Ivy Baer, senior director of health care affairs for the Association of American Medical Colleges (AAMC), wrote that her organization is still evaluating “whether the requirements related to infection control and antibiotics are the best way to tackle these issues.”

Related requirements for hospitals’ quality assessment and performance improvement programs would involve incorporating quality indicator data regarding hospital readmissions and HACs, according to a CMS fact sheet.

Medical Record Requirements

The rule included several new requirements regarding data inclusion in patients’ medical records. The new data would include information to justify all admissions and continued hospitalizations, support diagnoses, describe the patient's progress and responses to medications and services, and document all inpatient stays and outpatient visits to reflect all services provided to the patient.

Also required in patient records would be documentation of discharge and transfer summaries, including any patient discharge instructions.

The rule would clarify that patients should be able to access their medical records in a form and format that they request—including electronically or in a hard-copy format—if readily producible in that form and format. 

The medical record provisions drew a note of caution from one hospital advocacy group. The AAMC noted that although the organization supports a complete medical record, the primary purpose of the record is to supply the information needed for medical care.

“We will be speaking to our members about whether the proposed changes will meet that purpose,” Baer wrote.

Other Provisions

One of the provisions that would save hospitals money involves allowing patient nutritional needs to be met by a “qualified dietitian or qualified nutrition professional” instead of clinicians.

The change would allow dietitians and nutrition professionals to work to their full scope of practice and would provide $5 million in estimated annual savings for CAHs.

The rule also would require hospitals and CAHs to establish and implement a policy prohibiting discrimination against patients on the basis of race, color, religion, national origin, sex (including gender identity), sexual orientation, age, or disability.

CMS will accept comments on the rule through Aug. 15.


Rich Daly is a senior writer/editor in HFMA’s Washington, D.C. office. Follow Rich on Twitter: @rdalyhealthcare

Publication Date: Tuesday, June 14, 2016