March 10, 2014

Hospital-Acquired Conditions

Section 5001(c) of the Deficit Reduction Act of 2005 requires the
Secretary of Health and Human Services to identify conditions that are:
(a) high cost or high volume or both, (b) result in the assignment of a
case to a diagnosis related group (DRG) that has a higher payment when
present as a secondary diagnosis, and (c) could reasonably have been
prevented through the application of evidence-based guidelines.

If at discharge, there is a selected condition that was either not
identified by the hospital as present on admission, or could not be
identified based on data and clinical judgment at admission, it is
considered hospital-acquired. To encourage hospitals to avoid
hospital-acquired conditions, beginning October 1, 2008, Medicare no
longer pays hospitals at a higher rate for the increased costs of care
that result when a patient is harmed by one of the listed conditions if
it was hospital-acquired. Medicare prohibits the hospital from billing
the beneficiary for the difference between the lower and higher payment
rates. The inpatient prospective payment system fiscal year (IPPSFY)
2009 Final Rule is available from the Centers for Medicare and Medicaid Services (CMS) Web site External Web Site Policy

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Listed below by condition are evidence-based guideline resources
available on NGC to assist users in the prevention of the CMS-identified
hospital-acquired conditions.

Foreign Object Retained After Surgery (2)

Air Embolism (0)

Blood Incompatibility (1)

Stage III and IV Pressure Ulcers (5)

Falls and Trauma including fractures, dislocations, intracranial injuries, crushing injuries, burns, and electric shock (5)

Manifestations of Poor Glycemic Control (6)

Catheter-Associated Urinary Tract Infection (UTI) (8)

Vascular Catheter-Associated Infection (3)

Surgical Site Infection (4)

Deep Vein Thrombosis (DVT)/Pulmonary Embolism (PE) following total knee replacement and hip replacement (10)