The impact of hospital-acquired conditions on Medicare program payments.
OBJECTIVE
Hospital-acquired conditions, or HACs, often result in additional Medicare payments, generated during the initial hospitalization and in subsequent health care encounters. The purpose of this article is to estimate the incremental cost to Medicare, as measured by Medicare program payments, of six HACs.


METHODS
The researchers used a matched case-control design to determine the incremental increase in Medicare payments attributable to each HAC. For each HAC patient, five comparison patients were matched on diagnosis group, sex, race, and age. Using the matched sample, we estimated a hospital fixed effects log-linear regression on total Medicare payments for the episode of care, further controlling for co-morbid conditions. Care episodes included the initial hospitalization and all inpatient, outpatient, physician, home health, and hospice care that occurred within 90 days of hospital discharge.


METHODS
All Medicare fee-for-service patients discharged alive from a hospital between October 2008 and June 2010 with one of six HACs-severe pressure ulcer, fracture, catheter-associated urinary tract infection, vascular catheter-associated infection, surgical site infection following certain orthopedic procedures, or deep vein thrombosis/ pulmonary embolism following certain orthopedic procedures-were included in the sample and matched to five similar patients without the HACs.


RESULTS
The multivariate analysis suggests that Medicare paid an additional $146 million per year across these HAC care episodes compared with what would have been paid without the HACs.


CONCLUSIONS
HACs create a significant financial burden for the Medicare program. We compare the incremental Medicare payments for these six HACs to the current and upcoming Medicare HAC payment penalties.
RTI International.
Amy M G
AM
Kandilov
RTI International.
Nicole M
NM
Coomer
RTI International.
Kathleen
K
Dalton
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D055499:Catheter-Related Infections / Q000191:economics / Q000453:epidemiology; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006801:Humans; D007049:Iatrogenic Disease / Q000191:economics* / Q000453:epidemiology; D008297:Male; D006278:Medicare / Q000191:economics* / Q000706:statistics & numerical data; D003668:Pressure Ulcer / Q000191:economics / Q000453:epidemiology; D011655:Pulmonary Embolism / Q000191:economics / Q000453:epidemiology; D044469:Racial Groups / Q000706:statistics & numerical data; D012737:Sex Factors; D013530:Surgical Wound Infection / Q000191:economics / Q000453:epidemiology; D014481:United States / Q000453:epidemiology; D014546:Urinary Catheterization / Q000009:adverse effects; D020246:Venous Thrombosis / Q000191:economics / Q000453:epidemiology
Medicare; Medicare payments; access; demand; health care costs; hospital-acquired condition; hospitals; patient safety (measurement); quality of care; utilization of services