AHA exec comments on MS-DRGs

The October 2007 issue of Physician’s News Digest featured an interesting interview concerning MS-DRGs with Don May, the vice president for policy at the American Hospital Association (AHA).

In the interview, May reiterates AHA’s position on the behavioral offset and the association’s initial recommendation to CMS that the implementation of MS-DRGs take place over a four-year period. In essence, May said that CMS is moving much too quickly on MS-DRGs for the industry to adjust:

“What we’re going to see this year is a lot of confusion among hospitals not being able to identify what they’re going to get paid, or even knowing what the payment for any particular case is when they submit a claim to Medicare. The reason is that many vendors and fiscal intermediaries that pay Medicare claims have not yet put together software packages that hospitals can use to group claims into those new MS-DRG categories.”

On another issue, May states that the science behind preventing hospital-acquired infections is inconclusive in many cases:

We supported inclusion of three conditions for non-payment: air embolism, objects left in during surgery and wrong blood type. The other ones, we believe, need a little more thought. There are certain places where case-by-case review is really necessary. There are certain conditions where the science of exactly how to prevent them all the time is not developed yet. . . . For a lot of conditions, the hospital hasn’t determined whether it was present on admission because they didn’t do a test for, let’s say, urinary tract infection when the patient came into the hospital for a heart condition.

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