Government Regulatory Programs: Hospital Acquired Conditions

Added on Sep 15, 2015

Hospital Acquired Conditions

Established by the Affordable Care Act, the Hospital Acquired Conditions (HAC) Reduction Programcurrently affects hospitals participating in Inpatient Prospective Payment Systems (IPPS) and is expected to expand to more hospital categories. Beginning Fiscal Year 2015, a hospital’s HAC score isranked against a national benchmark. For those hospitals who fall into the bottom quartile, the Centers for Medicare and Medicaid Services (CMS) can withhold 1% of their reimbursement.

To receive full reimbursement, hospitals must rank above the bottom quartile on a combined score for HAC, which includes two weighted domains:

    • Hospital Acquired Infections (HAI) domain, which accounts for 65% of the total score
     • Patient Safety for Selected Indicators (PSI-90), which accounts for 35% of total score

HAI includes categories such as surgical site infections and catheter-associated urinary tract infections, and is continually expanding. Developed by the Agency for Healthcare Research and Quality, PSI-90 includes adverse events such as pressure ulcers or falls.

In addition to affecting 1% of payment, if the condition was not present on admission or if the medical record lacks proper documentation to determine if it was present on admission, CMS will not reimburse the hospital for any costs associated with the condition, including costs for an extended length of stay.

Reduce Hospital Acquired Conditions and Reduce Avoidable Suffering

Reducing the occurrences of HACs like pressure ulcers and falls is an important part of the initiative for hospitals to deliver high-quality, patient-centered care. Nursing-sensitive quality measures from theNational Database of Nursing Quality Indicators® (NDNQI®) allow the ability to compare HAI against variables like skill mix, acuity and staffing hours to identify how to improve in the areas that need it most.