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Winning the Battle: Hospital-Acquired Conditions Continue To Go Down

According to a report in Healthcare Finance, the Centers for Medicare & Medicaid Services (CMS) announced that fewer patients are affected by hospital-acquired conditions (HACs).1 From 2010 to 2014, 2.1 million fewer HACs have occurred with 87,000 fewer hospital-acquired condition related deaths, and $19.8 billion in costs have been averted, according to CMS Deputy Director Patrick Conway.

In the FY 2015 and FY 2016 programs, the average performance among eligible hospitals improved on two of the three measures included in both program years:2

  • The mean Patient Safety Indicator (PSI) 90 Composite Index Value decreased from 0.89 to 0.86 in FY 2016

  • The mean central line-associated bloodstream infection (CLABSI) standardized infection ratio (SIR) decreased from 0.53 in FY 2015 to 0.48 in FY 2016

  • The mean catheter-associated urinary tract infection (CAUTI) SIR increased slightly from 1.13 in FY 2015 to 1.17 in FY 2016

  • The mean surgical site infection (SSI) SIR in FY 2016, the first year that this measure was used in the program, was 0.95

What is the difference between hospital-acquired infections (HAIs) and hospital-acquired conditions (HACs)? HACs are serious conditions that a patient acquires while in the hospital and were not present on admission. HAC is an umbrella term that also includes HAIs. HAC identification came about as part of the Deficit Reduction Act of 2005, where CMS had to identify conditions that are:

  1. high cost or high volume or both

  2. result in the assignment of a case to a DRG that has a higher payment when present as a secondary diagnosis, and

  3. could reasonably have been prevented through the application of evidence-based guidelines

There are 14 categories of HACs listed below, including the new HACs from the IPPS FY 2013 Final Rule which are Surgical Site Infection Following Cardiac Implantable Electronic Device (CIED) and Iatrogenic Pneumothorax with Venous Catheterization.  For FY 2014 and FY 2015, there are no additional HACs added:3

  • 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 Catheterization

As involved as Infection Preventionists are with HAI reduction and elimination, it is good to realize that there are other adverse conditions, in addition to HAIs, that patients may develop which are monitored and evaluated by the C-suite and regulatory agencies.

There are many reports in the literature about reductions in HACs, including HAIs, that hospitals across the country are seeing. How is your hospital handling HACs? Do you have the resources you need to not only collect and report data but to intervene when data analysis suggests you may have a problem?



  1. Hospital-acquired conditions plummet, CMS says, touting new payment models. Healthcare Finance. 12 1 2015. Accessed January 10, 2015:

  1. Fiscal Year (FY) 2016 Results for the CMS Hospital-Acquired Conditions (HAC) Reduction Program. Accessed February 11, 2016:

  1. Hospital-acquired conditions. Accessed February 11, 2016:

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