Emily Kelley was taken to Emory 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 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 started noticing a decrease in reimbursement, and brought it up to the manager.
Why would the reimbursement rate decrease for this hospital?
What should the hospital do to determine why the infection rates are high?
What can patients do if they have choices of where to go for their care?