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Preventing Hospital-Acquired Conditions

Created Nov 12 2014, 07:00 PM by Lippincott Solutions
  • hospital-acquired conditions
  • Hospital Readmissions Reduction Program
  • Center for Medicare and Medicaid Services
  • federal incentives
  • financial penalties
  • preventable illnesses
  • HAC
  • Deficit Reduction Act
  • Medicare reimbursement
  • patient care
  • CMS

Thursday, November 13, 2014
Preventing Hospital-Acquired Conditions

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:

  • Foreign Object Retained After Surgery
  • Air Embolism
  • Blood Incompatibility
  • Stage III and IV Pressure Ulcers
  • Falls and Trauma

     - Fractures

- Dislocations

- Intracranial Injuries

- Crushing Injuries

- Burns

- Other Injuries

  • Manifestations of Poor Glycemic Control

- Diabetic Ketoacidosis

- Nonketotic Hyperosmolar Coma

- Hypoglycemic Coma

- Secondary Diabetes with Ketoacidosis

- Secondary Diabetes with Hyperosmolarity

  • Catheter-Associated Urinary Tract Infection (UTI)
  • Vascular Catheter-Associated Infection
  • Surgical Site Infection, Mediastinitis, Following Coronary Artery Bypass Graft (CABG)
  • Surgical Site Infection Following Bariatric Surgery for Obesity

- Laparoscopic Gastric Bypass

- Gastroenterostomy

- Laparoscopic Gastric Restrictive Surgery

  • Surgical Site Infection Following Certain Orthopedic Procedures

- Spine

- Neck

- Shoulder

- Elbow

  • Surgical Site Infection Following Cardiac Implantable Electronic Device (CIED)
  • Deep Vein Thrombosis (DVT)/Pulmonary Embolism (PE) Following Orthopedic Procedures

- Total Knee Replacement

- Hip Replacement

  • Iatrogenic Pneumothorax with Venous Catheterization

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:

  • Interface electronic health records to bedside monitors and medical devices.
  • Adhere to evidence-based medicine.
  • Create computerized checklists.
  • Transfer patients out of the ICU and ED as soon as appropriate. 
  • Standardize clinical language.

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?

 

 

 

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