Post-transfusion H&H

[Deny Morlino]

With the latest reimbursement guidelines from CMS indicating non-payment for readmissions within 30 days for the same issue, the transfusion committee decided to pursue post transfusion H&H's to help determine if transfusion of LRBC's was effective as expected, or if there was a reduced increase indicating some as yet addressed condition that should be resolved.  The committee also recommended an H&H the date of discharge for all LRBC transfused patients to be certain the patient was not decreasing Hgb, and that the patient has adequate Hgb as well (all of this is in conjunction with signs and symptoms).  The Med Exec committee did not agree.  I am looking for references and other facilities' practices to support the Transfusion Committee's stance.  Help?

[Malcolm Needs ☆]

With the latest reimbursement guidelines from CMS indicating non-payment for readmissions within 30 days for the same issue, the transfusion committee decided to pursue post transfusion H&H's to help determine if transfusion of LRBC's was effective as expected, or if there was a reduced increase indicating some as yet addressed condition that should be resolved.  The committee also recommended an H&H the date of discharge for all LRBC transfused patients to be certain the patient was not decreasing Hgb, and that the patient has adequate Hgb as well (all of this is in conjunction with signs and symptoms).  The Med Exec committee did not agree.  I am looking for references and other facilities' practices to support the Transfusion Committee's stance.  Help?

 

Sorry for being thick Deny, and don't forget that we have the NHS over this side of the pond, so I am speaking in complete and utter ignorance here as far as billing is concerned, but what happens in the case of a patient who is transfusion dependant, such as a patient with MDS, leukaemia, a haemoglobinopathy, etc?  Are you saying that the CMS (and, again, I am speaking in ignorance, because I don't know who are the CMS) would not pay for transfusions for such individuals?

 

 

Sorry if I am being even more stupid (and parochial) than normal!

[Deny Morlino]

Malcolm,

Valid question.  I am not certain how this is to be interpreted even after reading the CMS regulations regarding readmissions.  The purpose is to reduce the number of readmissions for the same billing code/DRG.  I am not certain how a readmission for such disease processes would be viewed in terms of reimbursement.  My supposition is that attempts to transfuse would occur on an outpatient basis as much as possible, thus reducing the costs associated with a hospital admission.  If readmission becomes inevitable, I am not sure how chronic transfusion disease processes would be reimbursed.

[Malcolm Needs ☆]

Thanks Deny.

[tbostock]

See attached; this is all I could find.

Discharge Hgb Level as a Marker for Utilization, Transfusion Journal Nov 2012.pdf

[goodchild]

Thank you for posting that article.

[SMILLER]

It looks to me like CMMS is focusing (for the time being) just on heart and pneumonia patients.  Not sure if many of these are re-admitted as inpatients for transfusions.

 

Interestingly, ir looks like they are talking about adding a monitor at some point not only for Medicare and medicaid patients, but for any uninsured patients as well. 

 

Scott

[Mabel Adams]

Yes, I just read something else recently that was talking about using discharge Hgb above 11 as a marker for over-transfusion.  With transfusion correlating to increased post-op infection rates, they may want to avoid transfusing, not look for more reasons to do so.  It's quite a tightrope we are being asked to walk these days when the evidence is not definitive but they want decisions to ride on it anyway.

[Deny Morlino]

Terri, Thanks for the article.

 

Scott, Thanks for the update

 

Mabel, I certainly agree.

 

I am struggling with a couple of physicians that, in my opinion, over transfuse regularly.  If I could get these few stragglers into line, we would be on track with the <7.0 g/dL target for the non-acute cardiac involvement recommendations from ARC.  The acute cardiac involvement set is a bit trickier.