Facing tightened reimbursement requirements from the government, hospitals must do everything in their power to make sure they are providing the best, most cost-efficient care.
One area that can cost hospitals dearly is when a patient contracts a hospital-acquired condition (HAC). A HAC is an undesirable situation or condition affecting a patient, the onset of which occurs during a hospital stay, and that experts believe can be reasonably prevented using a variety of best practices. Hospital-acquired infections are a big cause for concern, but other conditions such as pressure ulcers, injury from falls, and even deep vein thrombosis are also considered HACs.
As part of the Deficit Reduction Act (DRA) of 2005, hospitals do not receive additional payment for care surrounding one of the identified conditions if it was not present on admission. The Centers for Medicare and Medicaid Services (CMS) has listed the following categories of HACs:
- Intracranial Injuries
- Crushing Injuries
- Other Injuries
- Diabetic Ketoacidosis
- Nonketotic Hyperosmolar Coma
- Hypoglycemic Coma
- Secondary Diabetes with Ketoacidosis
- Secondary Diabetes with Hyperosmolarity
- Laparoscopic Gastric Bypass
- Laparoscopic Gastric Restrictive Surgery
- Total Knee Replacement
- Hip Replacement
In an effort to prevent HACs, the 469-bed Dallas VA Medical Center closely studied procedures in its intensive care unit setting, and recommended the following strategies to thwart infections:
HACs can lead to hospital readmissions, another problem that results in not just lost reimbursement, but also a record number of Medicare fines. Penalties are assessed when the number of Medicaid patients who are readmitted within 30 days of discharge exceeds a national benchmark.
The current penalties are based on readmissions from July 2010 through June 2013. The CMS penalties first went into effect in 2012 following the Hospital Readmissions Reduction Program (HRRP) as part of the Affordable Care Act. The HRPP requires the U.S. to reduce payments to hospitals with excess readmissions.
Has your facility been faced with HACs and/or hospital readmission problems? What are you doing to prevent such instances?