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Hospital-Acquired Conditions

Section 5001(c) of the Deficit Reduction Act of 2005 requires the Secretary to identify conditions that: (a) are 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.(1) Section 5001(c) provides that the Centers for Medicare and Medicaid Services (CMS) can revise the list of conditions from time to time, as long as it contains at least two conditions. The statute is available in the Statute/Regulations/Program Instructions External Web Site Policy section at the CMS Web site.(2)

For discharges occurring on or after October 1, 2008, hospitals will not receive additional payment for cases in which one of the selected conditions was not present on admission. That is, the case would be paid as though the secondary diagnosis were not present.(2)

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 (3)

  • NGC:010503
  • 1997 SEP (REVISED 2014 MAR)
Perioperative protocol. Health care protocol.

Air Embolism (0)

There are no guideline resources available on this condition at this time.

Blood Incompatibility (0)

There are no guideline resources available on this condition at this time.

Stage III and IV Pressure Ulcers (11)

  • NGC:010347
  • 2005 SEP 22 (REVISED 2014 APR)
Pressure ulcers: prevention and management of pressure ulcers.
  • Feb 2014
Guideline Synthesis: Prevention of Pressure Ulcers.

Falls and Trauma including fractures, dislocations, intracranial injuries, crushing injuries, burns, and other injuries (6)

  • NGC:009951
  • 2004 JUN (REVISED 2013 JUN)
Falls: assessment and prevention of falls in older people.
  • NGC:009514
  • 2003 SEP (REVISED 2012)
Fall management guideline.
  • NGC:009096
  • 2008 MAR (REVISED 2012 APR)
Prevention of falls (acute care). Health care protocol.

Manifestations of Poor Glycemic Control (5)

  • NGC:010503
  • 1997 SEP (REVISED 2014 MAR)
Perioperative protocol. Health care protocol.

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

Vascular Catheter-Associated Infection (4)

Surgical Site Infection, Mediastinitis, Following Coronary Artery Bypass Graft (CABG) (3)

  • NGC:010503
  • 1997 SEP (REVISED 2014 MAR)
Perioperative protocol. Health care protocol.

Surgical Site Infection Following Bariatric Surgery for Obesity (laparoscopic gastric bypass, gastroenterostomy, laparascopic gastric restrictive surgery) (1)

Surgical Site Infection Following Certain Orthopedic Procedures (spine, neck, shoulder, elbow) (2)

  • NGC:009741
  • 2007 JAN (REVISED 2012)
Antibiotic prophylaxis in spine surgery.

Surgical Site Infection Following Cardiac Implantable Electronic Device (CIED) (1)

Deep Vein Thrombosis (DVT)/Pulmonary Embolism (PE) following total knee replacement and hip replacement (8)

  • NGC:009698
  • 2001 SEP (REVISED 2013 FEB)
Antithrombotic therapy supplement.
  • NGC:009541
  • 2003 NOV (REVISED 2012 NOV)
Venous thromboembolism prophylaxis.

Iatrogenic Pneumothorax with Venous Catheterization (0)

There are no guideline resources available on this condition at this time.

References

  1. Centers for Medicare and Medicaid Services (CMS). Hospital-acquired conditions. [internet]. Baltimore (MD): Centers for Medicare and Medicaid Services (CMS); 2014 Aug 28. Available: http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/HospitalAcqCond/Hospital-Acquired_Conditions.html External Web Site Policy.
  2. Centers for Medicare and Medicaid Services (CMS). Hospital-acquired conditions (present on admission indicator). [internet]. Baltimore (MD): Centers for Medicare and Medicaid Services (CMS); 2014 Sep 29. Available: http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/HospitalAcqCond/index.html External Web Site Policy.

Page Last Reviewed or Updated: May 05, 2016