Why would the reimbursement rate decrease for hospital

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Reference no: EM133617488

"Hospital-Acquired Conditions and Present on Admission Indictor Reporting"

(Real-World Case) Emily Kelley was taken to Kirklake Community Hospital for pain in her side. She was admitted and taken into surgery, where her appendix was removed. In recovery her temperature spiked, and after looking at Emily's labs it was determined that she had developed an infection from the surgery. This was not the first surgery where an infection subsequently developed, and the current total HAC score for this hospital was 8. As a result of the high HAC score, the reimbursement to the hospital for Emily's surgery was less than it should have been based on APC grouping. The billers noticed a decrese in reimbursement and discussed it with the manager. The HIM manager approached the performance improvement manager to discuss the spike in HACs. She was able to provide the data to support an investigation into why this was happening. It was determined that the infections were occurring when a particular provider was on staff.

1. Why would the reimbursement rate decrease for this hospital?

2. What should the hospital do determine why the infection rates are high?

3. What can patients do if they have choices of where to go for their care?

Reference no: EM133617488

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