Journal Article

The impact of hospital-acquired conditions on Medicare program payments.

Kandilov AMG, Coomer NM, Dalton K. Medicare & medicaid research review. 2014;4.

In 2008, the Centers for Medicare and Medicaid Services (CMS) stopped paying for many preventable hospital-acquired conditions (HACs). However, according to this matched case-control study, HACs still result in numerous downstream financial effects, costing CMS an estimated $146 million per year. This study evaluated costs related to the index hospitalization and 90 days following discharge of six HACs—severe pressure ulcers, fractures, catheter-associated urinary tract infections, venous catheter-related infections, surgical site infections, and post-surgical venous thromboembolism. Severe pressure ulcers and orthopedic surgical site infections resulted in an average increase in payments of more than $20,000 across the episode of care. The extra costs are largely related to CMS index outlier payments, as well as payments for readmissions and post-acute care. A previous AHRQ WebM&M perspective by Dr. Peter Lindenauer discussed the business case for patient safety.