National Guideline Clearinghouse | Hospital-Acquired Conditions

National Guideline Clearinghouse | Hospital-Acquired Conditions

Hospital-Acquired Conditions

Section 5001(c) of the Deficit Reduction Act of 2005 requires the Secretary to identify conditions that: (a) are 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.(1) Section 5001(c) provides that the Centers for Medicare and Medicaid Services (CMS) can revise the list of conditions from time to time, as long as it contains at least two conditions. The statute is available in the Statute/Regulations/Program Instructions  section at the CMS Web site. (2)

For discharges occurring on or after October 1, 2008, hospitals will not receive additional payment for cases in which one of the selected conditions was not present on admission. That is, the case would be paid as though the secondary diagnosis were not present.(2)

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 (3)

Air Embolism (0)

Blood Incompatibility (3)

Stage III and IV Pressure Ulcers (12)

Falls and Trauma including fractures, dislocations, intracranial injuries, crushing injuries, burns, and other injuries (6)

Manifestations of Poor Glycemic Control (6)

Catheter-Associated Urinary Tract Infection (UTI) (7)

Vascular Catheter-Associated Infection (4)

Surgical Site Infection, Mediastinitis, Following Coronary Artery Bypass Graft (CABG) (3)

Surgical Site Infection Following Bariatric Surgery for Obesity (laparoscopic gastric bypass, gastroenterostomy, laparascopic gastric restrictive surgery) (1)

Surgical Site Infection Following Certain Orthopedic Procedures (spine, neck, shoulder, elbow) (2)

Surgical Site Infection Following Cardiac Implantable Electronic Device (CIED) (1)

Deep Vein Thrombosis (DVT)/Pulmonary Embolism (PE) following total knee replacement and hip replacement (9)

Iatrogenic Pneumothorax with Venous Catheterization (0)

References

1. Centers for Medicare and Medicaid Services (CMS). Hospital-acquired conditions. [internet]. Baltimore (MD): Centers for Medicare and Medicaid Services (CMS); 2014 Aug 28. Available: http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/HospitalAcqCond/Hospital-Acquired_Conditions.html.
2. Centers for Medicare and Medicaid Services (CMS). Hospital-acquired conditions (present on admission indicator). [internet]. Baltimore (MD): Centers for Medicare and Medicaid Services (CMS); 2014 Sep 29. Available:http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/HospitalAcqCond/index.html.