Final CMS rulings for hospital acquired conditions (HAC) now available

CMS has determined that the following 10 hospital acquired conditions (HAC) are subject to nonpayment
in fiscal year (FY) 2009:

1. Foreign Object Retained After Surgery
   
   
2. Air Embolism
   
   
3. Blood Incompatibility
   
   
4. Stage III and IV Pressure Ulcers
   
   
5. Falls and Trauma
   a. Fractures
   b. Dislocations
   c. Intracranial Injuries
   d. Crushing Injuries
   e. Burns
   f. Electric Shock
   
   
6. Manifestations of Poor Glycemic Control
   a. Diabetic Ketoacidosis
   b. Nonketotic Hyperosmolar Coma
   c. Hypoglycemic Coma
   d. Secondary Diabetes with Ketoacidosis
   e. Secondary Diabetes with Hyperosmolarity
   
   
7. Catheter-Associated Urinary Tract Infection (UTI)
   
   
8. Vascular Catheter-Associated Infection
   
   
9. Surgical Site Infection Following:
   a. Coronary Artery Bypass Graft (CABG)-Mediastinitis
   b. Bariatric Surgery
   c. Certain orthopedic surgeries
   
   
10. Deep Vein Thrombosis (DVT)/Pulmonary Embolism (PE)
    a. Total Knee Replacement
    b. Hip Replacement

• List of HAC expanded from 8 to 10 in the final ruling
  effective October 1, 2008
  
  
• All 10 conditions have been identified to be reasonably
  preventable through the application of evidence-based
  guidelines
  
  
• CMS is shifting focus from being a "passive payer" to an
  "active purchaser" of value based health care services.
  This is referred to as "Value Based Purchasing" (VBP)
  
  
• Goal is to improve patient outcomes and avoid
  unnecessary cost through quality initiatives and
  prevention programs

How can hospitals respond to these final rules?

• Educate clinical staff on POA indicators and HAC
  
  
• Use validated risk assessment and documentation tools
  
  
• Implement "tool kits" and "bundles" for prevention of HAC
  
  
• Incorporate evidence-based guidelines to address HAC
  
  
• Use best-practice products to prevent and treat HAC

For additional information: http://www.cms.hhs.gov/HospitalAcqCond/