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 (4)

Falls and Trauma including fractures, dislocations, intracranial injuries, crushing injuries, burns, and electric shock (8)

Manifestations of Poor Glycemic Control (2)

Catheter-Associated Urinary Tract Infection (UTI) (6)

Vascular Catheter-Associated Infection (6)

Surgical Site Infection (6)

Deep Vein Thrombosis (DVT)/Pulmonary Embolism (PE) following total knee replacement and hip replacement (11)