Understanding Hospital-Acquired Conditions
A hospital-acquired condition is a condition that a patient did not have upon admission but that developed during the inpatient stay, often considered reasonably preventable through the application of evidence-based guidelines. RHIA candidates should be familiar with the categories of conditions on the official HAC list and how they intersect with both payment policy and quality measurement.
Examples of Hospital-Acquired Conditions
- Catheter-associated urinary tract infections
- Central line-associated bloodstream infections
- Certain surgical site infections following specific procedures
- Falls resulting in serious injury during the inpatient stay
- Stage three and four pressure ulcers acquired during hospitalization
- Air embolism and foreign object retained after surgery
Two Distinct Payment Mechanisms
It is important to distinguish two separate policies that both use hospital-acquired condition data. The first, the HAC payment provision discussed alongside present on admission indicators, prevents individual claims from being paid at a higher DRG rate when a qualifying condition was not present on admission. The second, the Hospital-Acquired Condition Reduction Program, is a broader value-based payment program that reduces total Medicare payments by one percent for hospitals ranked in the lowest-performing quartile based on a composite HAC measure score across the entire fiscal year.
Measures Included in the Composite Score
The composite score typically incorporates measures from patient safety indicators and healthcare-associated infection data reported through the National Healthcare Safety Network, weighting different measure domains to produce an overall hospital score used to rank facilities nationally.
Strategies to Reduce HAC Rates
Hospitals reduce HAC rates through evidence-based prevention bundles, such as standardized catheter insertion and maintenance protocols, fall risk assessment programs, and skin integrity rounds, combined with accurate clinical documentation that reflects the true clinical picture and supports correct POA assignment.
HIM's Role in HAC Management
HIM professionals support HAC reduction efforts by ensuring coding accuracy, participating in clinical documentation improvement programs, and providing data analysis that helps clinical teams identify trends in preventable complications requiring intervention.
Exam Tip
Distinguish between the claim-level HAC payment provision and the annual, hospital-wide Hospital-Acquired Condition Reduction Program, since exam questions often test whether you understand these are two separate policies operating on different scales.