CMS: Falls as Hospital-acquired conditions
On February 8, 2006 the President signed the Deficit Reduction Act (DRA) of 2005 that required there be an adjustment in Medicare DRG (Diagnosis Related Group) payment for certain hospital-acquired conditions (HACs) with a component that addresses new Present on Admission (POA) coding. CMS has titled their program Hospital-Acquired Condition and Present on Admission Reporting (HAC and POA).
Section 5001(c) of the DRA required the Secretary to identify, by October 1, 2007, at least two conditions for which hospitals under the IPPS (Inpatient Prospective Payment System) would not receive additional payment beginning on October 1, 2008, if the condition was not present on admission. The conditions must be (a) high cost or high volume or both, (b) result in the assignment of a case to a DRG that has a higher payment when present as a secondary diagnosis, and (c) could reasonably have been prevented through the application of evidence-based guidelines.
Payment for hospital-acquired conditions (HAC)
For discharges occurring on or after October 1, 2008, hospitals would not receive additional payment for cases in which one of the selected HACs was not present on admission. That is, the case would be paid as though the secondary diagnosis was not present. Section 5001(c) provides that CMS can revise the list of conditions from time to time, as long as it contains at least two conditions. However, if the patient has another coded complication (that is not a HAC) then the case will still paid at the higher DRG level.
From the National Quality Forum's list of 28 "Serious Reportable Events" frequently referred to as "Never Events."
- Falls - Codes are not actually for "falls" but for potential adverse events or injuries occurring as the result of falls; injuries that should not occur during a patient’s hospitalization. The generic categories of coded injuries include: Fractures, dislocations, intracranial injury, crushing injury, burns, and other and unspecified effects of external causes.