Preventable hospital-acquired conditions: the whys and wherefores.

The changes to the Centers for Medicare & Medicaid Services (CMS) Inpatient Prospective Payment System published in the Federal Register (, Vol. 72, No. 162) on August 22, 2007, introduced the term preventable "hospital-acquired conditions" (HACs). These printed rules and regulations came about through a provision in the Deficit Reduction Act of 2005 (Pub. No. 109-171) and required the Secretary of the Department of Health and Human Services to track and report on conditions considered to be high cost, high volume (or both); assigned a higher paying "diagnosis related group" (DRG) when present as a secondary diagnosis; and were thought to be reasonably preventable when evidence-based guidelines were employed. In order to comply with this mandate, the CMS, a federal agency within Health and Human Services, was assigned the task of choosing "preventable" HACs, also referred to as "serious preventable events," for which reporting and tracking would be conducted; with the added opportunity of reporting and tracking data regarding a patient's "present on admission" condition. These preventable HACs become of particular interest to hospitals on October 1, 2008. That is the day CMS begins freeing itself from paying hospitals for the targeted preventable HACs that afflict Medicare patients during their hospital stay and which were not present at the time of the patients' admission to the hospital. It is a form of pay-for-performance.