CMS May Expand “Reasonably Preventable” Conditions List

The Centers for Medicare and Medicaid Services (CMS) recently proposed an expansion of the list of Hospital Acquired Conditions (HACs). When conditions appear on that list, Medicare no longer pays hospitals for any increased cost of care when a patient is harmed by one of those conditions, if those conditions were not present at the time of admission. HACs have been determined to be “reasonably preventable” as long as generally accepted guidelines are followed.

Medicare regulations for 2007 included HAC provisions to begin on October 1, 2007, which required hospitals to report whether certain specified diagnoses were present at the time of admission. The original eight conditions were selected because it was determined that they greatly complicate the treatment of the illness or injury that caused the initial hospitalization, and, according to CMS, resulted in higher payments to the hospital for patient care by both Medicare and patients. The original list included the following conditions: object inadvertently left in after surgery; air embolism; blood incompatibility; catheter associated urinary tract infection; pressure ulcer (decubitus ulcer); vascular catheter associated infection; surgical site infection after coronary artery bypass graft surgery; and certain types of falls and trauma.

Now, CMS is proposing to expand this list of conditions to include the following: surgical site infections following certain elective procedures; Legionnaires’ disease; extreme blood sugar derangement; collapse of the lung; delirium; ventilato-associated pneumonia; deep vein thrombosis/pulmonary embolism; staphylococcus aureus septicemia (bloodstream injection); and clostridium difficile associated disease (bacteria that cause severe diarrhea and intestinal conditions such as colitis). If finalized, beginning on October 1, 2008, Medicare would not pay hospitals at a higher rate for this any conditions on this list, or for those on the original list, if they are acquired during the hospital stay.

Please click here (PDF Download) to read the Academy's comments in opposition to the addition of DVT/PE to the Hospital Acquired Conditions list. Once the final rule is published, additional information will be available on the AAPM&R Web site.