If you’re not paying attention to the Affordable Care Act’s Hospital Acquired Condition (HAC) provisions, you should be. Based on their performance on Hospital Acquired Condition program measures, 724 hospitals lost a portion of their inpatient reimbursement fiscal year 2015.   The affected hospitals had high incidence rates for tracked HAC conditions, which consist of:

  • Foreign Object Retained After Surgery
  • Air Embolism
  • Blood Incompatibility
  • Stage III and IV Pressure Ulcers
  • Falls and Trauma
    • Fractures
    • Dislocations
    • Intracranial Injuries
    • Crushing Injuries
    • Burn
    • 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 Certain Orthopedic Procedures:
    • Total Knee Replacement
    • Hip Replacement
  • Iatrogenic Pneumothorax with Venous Catheteriztion

According to an article titled “Hospital-Acquired Infections Cost $10 Billion a Year: Study” that appeared in September 3rd, 2013 Health Day (Hospital-Acquired Infections Cost $10 Billion a Year: Study) the five most common infections that patients get after they’ve been admitted to the hospital cost the U.S. health care system almost $10billion a year.

On the other hand, several studies have called into the question the number and magnitude of reported hospital acquired conditions. since accuracy in HAC reporting is based upon both the accuracy of physician clinical documentation as well as the accuracy of coder assignment of the appropriate Present on Admission (POA) designation (Y, N, W, U). This issue is addressed in a study released on June 30,2012 titled Accuracy of Coding in the Hospital Acquired Conditions Present on Admission Program “You may read the study here…

Additionally, a pertinent article from the Report on Medicare Compliance rightfully raises the question of coding and clinical documentation accuracy playing a significant role in the decreased reimbursement being received by the 724 hospitals who scored on the low end of the hospital acquired conditions calculations.

Regardless of concerns regarding factors that can affect accurate reporting of HACs, these conditions are being tracked and good performance on these measures can be critical to your organization.

A word to the wise: Now is an excellent time to evaluate your processes and initiate action to insure accurate and complete documentation to support physicians and coders in their quest to accurately document and assign Present on Admission Indicators.