Hospital Acquired Condition

A Hospital Acquired Condition (HAC) is an undesirable situation or a condition affecting a patient arising during a time spent in a hospital or medical facility. It is a designation used by Medicare/Medicaid in the United States of America for determining MS-DRG reimbursement beginning with version 26 (October 1, 2008).

Description

A patient at a hospital can be infected or otherwise degraded by hospital conditions and/or personnel in ways that are sometimes diagnosed as a "complication". Medicare designates some 1000+ ICD-9-CM diagnoses, out of over 14000 (as of 2009), as possible HACs. If a diagnosis is determined to be a HAC, it is demoted and therefore no longer counts as a complication. This possibly, but not necessarily, decreases the compensation paid to the hospital. For instance, if a patient has multiple complications, but only one of them is a demoted HAC, the other complications still count.

Categories of Hospital Acquired Condition

The following are the current, as of October 1, 2009 (MS-DRG v27), Hospital-Acquired Conditions:

1. Foreign object retained after surgery
2. Air embolism
3. Blood incompatibility
4. Pressure ulcer
5. Falls and trauma
6. Catheter associated urinary tract infection (UTI) (Diag)
7. Vascular catheter-associated infection
8. Infection after coronary artery bypass surgery (CABG) (Proc)
9. Manifestations of poor glycemic control
10. Deep venous thrombosis or pulminary embolism (DVT/PE) after knee or hip replacement (Proc)
11. Infection after bariatric surgery (Diag and Proc)
12. Infection after certain orthopedic procedures of spine, shoulder, and elbow (Proc)

Almost all of the 1000+ diagnoses which are possible HACs are designated "Falls and trauma".

How HAC is determined

When a diagnosis is recorded, it is designated either Present on Admission (POA) or not. If the diagnosis is POA, it is not demoted.

However, if a diagnosis is not POA, it might be demoted. Most HAC diagnoses are demoted if they are not POA. Those which are not so simple, are designated above with the tag "Proc" or "Diag" or both. In those situations, a diagnosis must also be accompanied by one of a specific set of diagnoses, procedures, or both, in order to be demoted.

For instance, if a patient falls out of bed while in a hospital, the consequent broken hip was not present on admission, so the "complication" of "broken hip" would be demoted as a "Falls and trauma" HAC. The hospital would not be compensated for treatment of the injury. The intent of this sort of classification is to force hospitals to prevent such problems in the first place.