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.
• Increase patient’s protection
• Implement best practices to decrease rate of infections
The HAC Reduction Program applied to all subsection (d) hospitals, defined under the Social Security Act (SSA).
• 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.
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.
CMS PSI 90 – Patient Safety and Adverse events composite
CMS calculate this measure using Medicare Fee-for-service claims.
• 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
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 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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