Hospital Acquired Conditions (HACs). Overview The Deficit Reduction Act of 2005 (DRA) requires a quality adjustment in Medicare Severity Diagnosis Related.

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Presentation transcript:

Hospital Acquired Conditions (HACs)

Overview The Deficit Reduction Act of 2005 (DRA) requires a quality adjustment in Medicare Severity Diagnosis Related Group (MS-DRG) payments for certain hospital-acquired conditions. CMS has titled the provision “Hospital-Acquired Conditions and Present on Admission Indicator Reporting” (HAC & POA).

HACs continued 1.Are high cost or high volume or both 2.Result in the assignment of a case to an MS- DRG (Medicare Severity – Diagnosis Related Group) that has a higher payment when present as a secondary diagnosis 3.Could reasonably have been prevented through the application of evidence-based guidelines

What’s All The Fuss About? On October 1, 2007, all Inpatient Prospective Payment System (IPPS) Hospitals were required to begin submitting Present on Admission (POA) Indicator information for all primary and secondary diagnoses. Beginning April 1, 2008, claims that were submitted for payment that do not contain proper reporting of the POA Indicator are being RETURNED.

What’s All The Fuss About?

Famous 3’s

Three Categories of HACs: 1.Never Events / Rare Occurrences 2.Infection Prevention 3.Patient Safety

Never Events / Rare Occurrences Delivery incompatible blood products Foreign object left in during surgery Air embolism

Infection Prevention Catheter-Associated Urinary Tract Infection (CAUTI) Vascular Catheter-Associated Infections 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)

Patient Safety Falls and Trauma (Fracture, Dislocation, Intracranial Injury, Crushing Injury, Burn, etc.) Pressure Ulcers Manifestations of Poor Glycemic Control (Diabetic Ketoacidosis, Nonketotic Hyperosmolar Coma, Hypoglycemic Coma, Secondary Diabetes with Ketoacidosis, and Secondary Diabetes with Hyperosmolarity) Deep Vein Thrombosis (DVT) and Pulmonary Embolism (following Total Hip and Knee Replacements)

Is It Good That We Monitor HACs?

Remember the Famous 3’s?

Hear No Evil Speak No Evil See No Evil