Changes in Medicare reimbursement for hospital-acquired conditions including infections.

As part of the Deficit Reduction Act of 2005, Congress required the Secretary of Health and Human Services (HHS) to identify conditions that (1) are high cost or high volume or both, (2) result in the assignment of a case to a diagnosis-related group that has a higher payment when present as a secondary diagnosis, and (3) could reasonably have been prevented through the application of evidence-based guidelines. For the conditions identified and discharges occurring on or after October 1, 2008, hospitals do not receive additional payment for cases in which one of the selected conditions was not present on admission (POA). That is, the case would be paid as though the secondary diagnosis were not present. The US Centers for Medicare and Medicaid Services (CMS) prohibits the hospital from billing the beneficiary for the difference between the lower and higher payment rates. Rather, the hospital is being encouraged to prevent an adverse event and improve the quality of care it is giving to Medicare patients. There are 6 categories of hospital-acquired conditions that were identified by CMS, 3 of which were related to health careassociated infections: (1) selected surgical site infections, (2) vascular catheter-associated infections, and (3) catheter-associated urinary tract infections. The other 3