Role of States to Track and Report Hospital-Acquired Conditions (HACs)

Medical errors and other serious adverse events rank as a leading cause of preventable death in the U.S. Many states mandate hospitals to report hospital-acquired conditions (HAC), such as the rate of foreign objects retained in the body after surgery or catheter-associated urinary tract infections. The focus of our research, which is one aspect of evaluating the Hospital-Acquired Conditions-Present on Admission (HAC-POA) Program, is on the 10 categories of HACs identified in the Inpatient Prospective Payment System (IPPS) Fiscal Year 2009 Final Rule, which the Centers for Medicare & Medicaid Services (CMS) has determined will no longer receive additional Medicare payment when one of these reasonably preventable conditions was not present on admission. Our preliminary findings have found that just over half the states have reporting systems authorized and operated by state governments to collect reports from hospitals about HACs, with the intent to improve patient safety. We distinguish between three distinct types of reporting systems: (1) those that focus on the collection of information of serious reportable events; (2) those that focus on the impact of HACs on clinical outcomes, i.e. morbidity and mortality; and (3) those that focus on hospital-acquired infections (HAI). We performed document reviews of state regulations and public reports, held telephone discussions with state personnel, and consulted the Centers for Disease Control and Prevention on their current initiative to implement HAI Prevention State Plans. States make use of these data collected from reporting systems in a variety of ways, including regulatory (mandatory) and quality improvement (voluntary) functions. Many states monitor HAC incidence and trends over time or share best practices in prevention across hospitals. In some cases, states hold facilities accountable through correction action. States are increasingly mandating public reporting of HACs as greater transparency is called on regarding hospital patient safety improvements or deficiencies.