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August 2008
Vol. 18 No. 8
Medicare Adds Only One New HAC to the List for Nonpayment in 2009

IDSA and the Society for Healthcare Epidemiology of America (SHEA) were successful this summer in making the case that Medicare should take a cautious approach in implementing a new policy to limit payment to hospitals for secondary diagnoses that are not present on admission—commonly referred to as hospital-acquired conditions (HACs).

As of Oct. 1, 2008, hospitals will not receive additional payment for several conditions if they were not present on admission. The conditions most relevant to infectious disease are catheter-associated urinary tract infections, vascular catheter-associated infections, and mediastinitis after coronary artery bypass graft surgery.

Recently, the Centers for Medicare and Medicaid Services (CMS) proposed adding several additional conditions to the list for 2009, including certain surgical site infections, Legionnaires’ disease, ventilator-associated pneumonia, Staphylococcus aureus septicemia, Clostridium difficile-associated disease, and methicillin-resistant Staphylococcus aureus. Thanks in part to efforts by IDSA and SHEA, CMS added only one new condition for next year: expanding the category for surgical site infections to include certain orthopedic procedures and beriatric surgery for obesity.

In a letter to CMS, the two medical societies had expressed concern that even the best hospitals may not be able to eliminate these conditions entirely over time, even with complete adherence to evidence-based guidelines. Furthermore, there could be unintended consequences, such as causing hospitals to misdirect resources that could be better spent on infection prevention.

Although IDSA and SHEA leaders are pleased with this latest development, CMS could reconsider the other conditions in future years. (See IDSA News, June 2008.)
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