PPCs are divided into two categories: healthcare-acquired conditions as defined by hospital-acquired conditions under Medicare and “other provider-preventable conditions” which states could individually specify for reductions in Medicaid payments. Medicare hospital-acquired conditions include foreign objects retained after surgery, air embolism and blood incompatibility.
CMS has suggested states choose OPPCs based on the following guidelines: Conditions and events should be discrete, auditable, quantifiable and clearly defined; condition or event must be clearly adverse; and the condition or event must be reasonably preventable.
Under the proposed rule, the payment reductions would be applied nationwide and states would be allowed to add more OPPCs that could result in reduced Medicaid payments. The rule would be applied beyond the hospital inpatient setting, to outpatient hospitals, nursing facilities and ambulatory surgery centers.
Read the proposed rule about provider-preventable conditions under Medicaid (pdf).
Read other coverage about Medicare and Medicaid payments:
– Upcoming Fee Fix Would Mean Squeezing Hospital, Physician Payments
– Still Insisting on Higher Payments, Connecticut Hospitals Look for Efficiencies
