What Are Hospital-Acquired Conditions
Hospital-acquired conditions, or HACs, are specific conditions that CMS has determined are reasonably preventable through the application of evidence-based guidelines and that were not present on admission. CMS maintains a defined list of HACs used to adjust hospital payment and evaluate patient safety performance.
The CMS HAC List
The HAC list includes conditions such as foreign object retained after surgery, air embolism, falls and trauma resulting in serious injury, catheter-associated urinary tract infections, vascular catheter-associated infections, certain surgical site infections, and stage three or four pressure ulcers acquired during the hospital stay. CMS periodically reviews and updates the list based on clinical evidence and stakeholder input.
Present on Admission Reporting
Accurate present on admission indicator assignment is essential to HAC determination. If a qualifying condition is coded as not present on admission, meaning it developed during the hospitalization, it is treated as a HAC for payment purposes. Coders rely on precise clinical documentation to assign the correct POA indicator for each diagnosis.
Payment Implications
Under the HAC Payment Reduction Program, hospitals ranked in the lowest-performing quartile on HAC measures receive a reduction to their total Medicare payments. Additionally, under the original HAC provisions from the Deficit Reduction Act, cases where a HAC is the only complication or comorbidity present are not paid at the higher MS-DRG rate that the condition would otherwise trigger.
Prevention Strategies
Because HACs carry both patient safety and financial consequences, hospitals implement evidence-based prevention bundles for conditions such as catheter-associated infections and pressure ulcers, along with fall prevention protocols and surgical safety checklists. Multidisciplinary teams including nursing, infection prevention, and quality staff collaborate on these prevention initiatives.
Quality Impact
HAC rates also factor into public quality reporting and value-based purchasing calculations, making accurate identification and prevention a shared priority across clinical, quality, and HIM departments. HIM professionals support this effort by ensuring coding accuracy, participating in HAC data validation, and helping identify documentation improvement opportunities related to POA reporting.