According to CMS, the Hospital-Acquired Condition (HAC) Reduction Program inspires hospitals to improve patients’ protection and reduce the number of conditions people experience from their time in a hospital, such as pressure sores and hip fractures after surgery.

Importance of HAC Reduction Program

The HAC Reduction Program important because this program encourages hospitals for:

Increase patient’s protection

Implement best practices to decrease rate of infections

Use of HAC Reduction Program

The HAC Reduction Program applied to all subsection (d) hospitals, defined under the Social Security Act (SSA).

Exempted Hospital list from HAC Reduction Program:

Long-term care hospitals

Psychiatric hospitals and units

Children’s hospitals

Prospective Payment

Critical access hospitals

Rehabilitation hospitals and units

System-exempt cancer hospitals

Veterans Affairs medical centers and hospitals

Short-term acute care hospitals located in U.S. territories (Guam, the Northern Mariana Islands, the U.S. Virgin Islands, Puerto Rico, and American Samoa)

Religious nonmedical health care institutions

To know more or to get full description of subsection (d) hospitals, you can visit to the Social Security Act on the Social Administration’s website.

Maryland Hospitals Exemption from HAC Reduction Program

Hospitals from Maryland are exempted from payment reduction under the HAC reduction program because they use a waiver agreement between CMS and the state of Maryland.

HAC Reduction Program

Here is the list of some measures which are included in the HAC Reduction Program:

CMS PSI 90 – Patient Safety and Adverse events composite

CMS calculate this measure using Medicare Fee-for-service claims.

The CMS PSI 90 measure includes:

PSI 03: Pressure Ulcer Rate

PSI 06: Iatrogenic Pneumothorax Rate

PSI 08: In Hospital Fall with Hip Fracture Rate

PSI 09: Perioperative Hemorrhage or Hematoma Rate

PSI 10: Postoperative Acute Kidney Injury Requiring Dialysis Rate

PSI 11: Postoperative Respiratory Failure Rate

PSI 12: Perioperative Pulmonary Embolism or Deep Vein Thrombosis Rate

PSI 13: Postoperative Sepsis Rate

PSI 14: Postoperative Wound Dehiscence Rate

PSI 15: Unrecognized Abdominopelvic Accidental Puncture/Laceration Rate

CDC and Prevention's National Healthcare Safety Network healthcare-associated infection (HAI) measures:

Calculation of the following HAI measures using data of infections taken from reports, charts and other sources and reported to the National Healthcare Safety Network:

Surgical Site Infection (SSI) (for colon and abdominal hysterectomy procedures)

Methicillin-resistant Staphylococcus aureus (MRSA) bacteremia

Clostridium difficile Infection (CDI)

Central Line-Associated Bloodstream Infection (CLABSI)

Catheter-Associated Urinary Tract Infection (CAUTI)

Payment Update under the HAC Reduction Program

Payment adjustment is the first step for the Hospital Value-Based Purchasing Program, disproportionate share hospital payments, Hospital Readmissions Reduction Program, and indirect medical education payments based on the base-operating diagnosis-related group amount. Then, the HAC Reduction Program payment deduction is applicable based on the overall Medicare payment amount. Click here (Acute Payment System Fact Sheet (PDF)) to get the detailed information on the Inpatient Prospective Payment System methodology.

Payment adjustment carried out under the HAC Reduction Program only in case of hospital claims. The payment reduction is application for all patient received discharge under the Medicare fee-for-service in the corresponding fiscal year. Detailed information is available on the QualityNet HAC Reduction Program Scoring Methodology section

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Published By - Medical Billers and Coders
Published Date - Nov-10-2020 Back

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