Browse By Topic and Related Items

Topic Browser

Related Items

Bookmark and Share

Hospital-Acquired Condition (HAC) Guidelines Produce $20M in Medicare Savings

From: The Hospitalist, September 2010

Falls and trauma account for 34% of all HACs reported from October 2008 to June 2009, followed by vascular catheter-associated
infection (16%) and catheter-associated UTIs (16%).


How much has Medicare saved by not paying hospitals when patients get infections?
Hugh Black, DO
Charlotte, N.C.

Dr. Hospitalist responds: Since 2007, the Centers for Medicare and Medicaid Services (CMS) has tried to reduce the number of high-cost, hospital-acquired conditions (HACs), including infections, by encouraging providers to adhere to evidence-based guidelines. Some examples of these hospital-acquired conditions include:

  • Catheter-associated urinary tract infections;
  • Foreign objects retained after surgery; and
  • Stage III and IV pressure ulcers.

CMS requires that acute-care hospitals, “effective with discharges occurring on or after Oct. 1, 2007, submit information on Medicare claims specifying whether diagnoses were present on admission.” Effective Oct. 1, 2008, Medicare no longer pays for charges associated with these HACs. So, if a Medicare beneficiary developed a Stage III pressure ulcer during his stay at an acute-care hospital, CMS would not pay for the incremental cost of the care associated with the “HAC.”

Medicare’s Potential New Hospital-Acquired Conditions
click for large version

The U.S. government, in the May 4, 2010, edition of the Federal Register, reviewed the impact of this program. The data are based on Medicare claims data from October 2008 to June 2009. During this period of time, there were approximately 7.17 million acute-care hospital Medicare discharges.

The total net savings during this nine-month period for all HACs was $16.4 million. Three HACs (Stage III and IV pressure ulcers, DVT/PE after orthopedic procedure, and falls and trauma) accounted for more than $15.1 million in savings. Pro-rated for a 12-month period, the total net savings for all HACs would exceed $20 million.

Falls and trauma accounted for 34% of all HACs reported (11,253), followed by vascular catheter-associated infection (16%) and catheter-associated UTIs (16%). Air embolism and mediastinitis after CABG were the least recorded HACs; both were less than .01% if the total.

The goal is that, over time, with improvement in care, there would be a decrease in the number of hospital discharges where these conditions would be present. Therefore, the net savings would be expected to decline.

ASK Dr. Hospitalist

Do you have a problem or concern that you’d like Dr. Hospitalist to address? E-mail your questions to

Medicare has considered a number of other HACs for this program, and reviewed the numbers of these conditions over the same nine-month period (see “Medicare’s Potential New Hospital-Acquired Conditions,” above). Despite some large numbers, CMS has stated it’s not proposing to add or remove HAC categories at this time. If you are interested in reviewing the entire report, visit 2010-9163.pdf. TH

This copy is for your personal, noncommercial use only. No part of this article can be reproduced without the written permission of the publisher. Order presentation-ready copies for distribution to your colleagues, clients, or customers by contacting our reprints department at Copyright © 2009 Society of Hospital Medicine, administered by John Wiley & Sons Inc.

current issue

October 2014


The Hospitalist newsmagazine reports on issues and trends in hospital medicine. The Hospitalist reaches more than 25,000 hospitalists, physician assistants, nurse practitioners, residents, and medical administrators interested in the practice and business of hospital medicine.

Copyright © 2000–2014 by John Wiley & Sons, Inc. or related companies. All rights reserved.

ISSN: 1553-085X