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June 19, 2013

CMS Releases Data on Hospital Acquired Conditions

The Centers for Medicare & Medicaid Services (CMS) released data today about hospital acquired conditions (“HACs”) at more than 4,700 hospitals. HACs are defined in Section 5001(c) of the Deficit Reduction Act of 2005 as those conditions that are:

  1. High cost or high volume or both;
  2. 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
  3. Could reasonably have been prevented through the application of evidence-based guidelines.

CMS’ press release notes that HAC rates, reported as number of HACs per 1,000 discharges, will provide “important clues about the state of patient safety in American’s hospitals,” including how often potentially life-threatening events take place. The data provides the number of HACs at each of the hospitals that occurred for Medicare fee-for-service patients between October 2008 and June 2010.

In the fiscal year 2011 Inpatient Prospective Payment System Final Rule, CMS selected eight HACs for reporting:

  1. Foreign object retained after surgery
  2. Air embolism
  3. Blood incompatibility
  4. Pressure ulcer stages III and IV
  5. Falls and trauma
  6. Vascular catheter-associated infection
  7. Catheter-associated urinary tract infection
  8. Manifestations of poor glycemic control

The Hospital Compare website with HAC data may be found by following this link. The CMS April 6 press release may be found by following this link, and the CMS Medicare Fact Sheet on HACs may be accessed here.

©2013 von Briesen & Roper, s.c

About the Author

Meghan O’Connor is a member of the Health Care Practice Group. Her practice focuses on general health law including managed care and provider contracting, risk management, and regulatory compliance.

Prior to joining von Briesen, Meghan worked for the Centers for Medicare and Medicaid Services where she consulted with states regarding federal health law, regulation and policy, evaluating managed care contracts and conducting compliance reviews.

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