Quality Definitions and Methodology

Hospital Acquired Conditions

A Hospital Acquired Condition (HAC) is a medical condition or complication that a patient develops during a hospital stay, which was not present at admission. In most cases, hospitals can prevent HACs when they give care that research shows gets the best results for most patients.

For discharges occurring on or after October 1, 2008, hospitals will not receive additional payment for cases in which one of the selected conditions was not present on admission. That is, the case would be paid as though the secondary diagnosis were not present. CMS required hospitals to report present on admission information for both primary and secondary diagnoses when submitting claims for discharges on or after October 1, 2007.

The report is based on information from Medicare fee-for-service claims from short term, acute care hospitals and is not case-mix adjusted. Columns are defined as follows:

Rate per Thousand
[Rate per 1000 discharges] = [(Number of HACs / Number of Patients) x 1000]
National Rate
[National HAC Rate] = [(National HAC count/National number of eligible discharges) x 1000]

The specific measures are defined in terms of ICD-9 codes for complications appearing on Medicare claims:

Measure Complications (CC/MCC ICD-9 Codes)
Air Embolism 999.1 (MCC)
Blood Incompatibility 999.60 (CC)
999.61 (CC)
999.62 (CC)
999.63 (CC)
999.69 (CC)
Catheter-Associated Urinary Tract Infection (UTI) 996.64 (CC)
Also excludes the following from acting as a CC/MCC:
112.2 (CC)
590.10 (CC)
590.11 (MCC)
590.2 (MCC)
590.3 (CC)
590.80 (CC)
590.81 (CC)
595.0 (CC)
597.0 (CC)
599.0 (CC)
Falls and Trauma: Fracture
Intracranial Injury
Crushing Injury
Electric Shock
Codes within following CC/MCC ranges: 800-829
Foreign Object Retained After Surgery 998.4 (CC)
998.7 (CC)
Manifestations of Poor Glycemic Control: Diabetic Ketoacidosis
Nonketotic Hyperosmolar Coma
Hypoglycemic Coma
Secondary Diabetes with Ketoacidosis
Secondary Diabetes with Hyperosmolarity
250.10-250.13 (MCC)
250.20-250.23 (MCC)
251.0 (CC)
249.10-249.11 (MCC)
249.20-249.21 (MCC)
Pressure Ulcer Stages III & IV 707.23 (MCC)
707.24 (MCC)
Vascular Catheter-Associated Infection 999.31 (CC)