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What are Hospital-Acquired Conditions?

 In Medical Malpractice, Personal Injury

Patients go to hospitals hoping to recover from illnesses and injuries and regain their strength and health. At this most unfortunate time, the patient may suffer from Hospital-Acquired Conditions (HAC), which can leave a person worse than when he or she entered the medical facility. If you or a loved one has suffered a hospital-acquired condition while receiving medical care in a hospital or other medical facility, contacting Ferrera Law can help you understand your rights.

What are Hospital-Acquired Conditions?

Hospital-Acquired Conditions are infections or other conditions that are sometimes diagnosed as “complications” during a patient’s medical facility stay. Hospital-Acquired Conditions are medical complications or conditions that were not present when the patient was admitted. These HACs result in a secondary diagnosis that has further injured the patient beyond his or her initial diagnosis. Rather, HACs are ultimately a form of medical malpractice, as victims face personal injury including lost wages and medical bills as a result of this hospital-acquired harm.

Recognized Hospital-Acquired Conditions

While the types of infections and secondary diagnoses from hospital and medical facility stays are numerous, only a limited number of hospital-acquired conditions are legally recognized. In 2005, Congress passed the Deficit Reduction Act, which required the Secretary of Health and Human Services to formally list the legally identifiable Hospital-Acquired Conditions.

The Deficit Reduction Act also required hospitals and medical facilities to report secondary diagnoses that are present on admission. Additionally, in 2008, the Centers for Medicare and Medicaid Services formally created a list of 10 conditions that are legally identified as Hospital-Acquired Conditions by law. In 2013, this list of 10 Hospital-Acquired Conditions expanded to 14 conditions recognized by law.

The 14 Hospital-Acquired Conditions

The 14 legally identified Hospital-Acquired Conditions recognized by the Centers for Medicare and Medicaid Services’ include the following:

  1. Air embolisms
  2. Blood incompatibility
  3. Catheter-associated urinary tract infections
  4. Deep vein thrombosis
  5. Pulmonary embolism following certain procedures
  6. Falls and traumas
  7. Foreign objects retained after surgery
  8. Iatrogenic pneumothorax with venous catheterization
  9. Manifestations of poor glycemic control
  10. Stage III and IV pressure ulcers
  11. Surgical site infection following bariatric surgery
  12. Surgical site infection following cardiac implantable electronic device
  13. Surgical site infection following certain orthopedic procedures
  14. Vascular catheter-associated infections

Section 5001(c) of the Deficit Reduction Act

As previously stated, Section 5001(c) of the Deficit Reduction Act requires the Secretary of Health and Human Services to identify the following conditions that are high cost or high volume or both, result in the assignment of a case to a DRG that has a higher payment when present as a secondary diagnosis, and could reasonably have been prevented through the application of evidence‑based guidelines.

These guidelines are significant because of Deficit Reduction Act requires that for any inpatient discharges after October 1, 2008, that have Hospital-Acquired Conditions that were not Present On Arrival by the patient, Medicare will no longer pay for the additional services needed to treat the Hospital-Acquired Conditions.

The inability for these medical institutions to receive additional payment impacts them financially, as there is a clearly a higher payment required when Hospital-Acquired Conditions are present in a patient and requires management. This financial impact has motivated hospitals and medical facilities to attempt to reduce all Hospital-Acquired Conditions in their facilities.

Hospitals With Poor Records Regarding HACs

The Centers for Medicare and Medicaid Services created a list of hospitals and medical facilities that report inordinately high numbers of Hospital-Acquired Conditions in their facilities. Additionally, patients can perform due diligence on their hospital and see how well they are doing to prevent HAC’s. Patients are able to take control of their health by referring to these resources, to determine if their hospital or medical care facility has inordinately high numbers of Hospital-Acquired Conditions or if they have none.

Improvement in Hospital-Acquired Conditions Nationwide

Centers for Medicare & Medicaid Services set a goal to reduce HACs from 2014 through 2019 by 20%. The AHRQ National Scorecard on Hospital-Acquired Conditions encouragingly states that 350,000 Hospital-Acquired Conditions were avoided and there was a reduction of the HAC rate by a full 8% from 2014 to 2016. These gains in safety are victories for hospital patients and a testament to the hospitals and medical facilities that are working toward better care for all.

If the entire Centers for Medicare & Medicaid Services meets their 20% reduction goal, 1.8 million fewer patients would suffer from HACs, which would result in resulting in 53,000 fewer deaths and saving $19.1 billion in hospital costs from fiscal year 2015 through 2019.

This work towards safer hospitals is important.  Patients are still suffering injuries due to Hospital-Acquired Conditions.

Medical Malpractice Implications

As hospitals, medical facilities, nurses, doctors, and medical staff attempt to comply with regulations regarding Hospital-Acquired Conditions and Present On Arrival standards, many questions arise regarding medical malpractice. When the Centers for Medicare & Medicaid Services refuse to pay for certain HAC’s, it conveys a strong indication that the hospital or medical professional violated a standard of care.  Violation of a standard of care required by a hospital, medical facility or medical professional can be grounds for a medical malpractice lawsuit.

Physicians and medical facilities commit medical malpractice when they violate their duty towards a standard of care accepted within the community and by law.  If these regulatorily-anointed guidelines are evidence that a violation occurred, they can be also seen as elements to prove negligence.

Medical malpractice law is complex, and if you were injured due to the negligence of a hospital or medical facility, or its staff, you should contact an experienced medical malpractice attorney to understand your rights and determine if you have a case to compensate you for your damages.

Contact a Compassionate Medical Malpractice Attorney

Facing medical issues is challenging, but if you or a loved one suffered from these incidents in a medical facility or hospital, speaking to an experienced medical malpractice attorney can help you understand your rights. At Ferrara Law, we understand just how devastating the effects of medical malpractice can be. As a result, we remain committed to fighting tirelessly for the results that victims deserve. Contact Ferrera Law at 856-779-9500 or online today.

The Ferrara Law Firm
Mr. Ferrara is the owner of The Ferrara Law Firm L.L.C. and is admitted to practice before the U.S. Supreme Court, the New Jersey Supreme Court, the Pennsylvania Supreme Court and the Federal Courts.
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