Hospitals Should Focus on Complications Beyond CMS List, Report Says

The list of hospital acquired conditions (HACs) subject to a specific payment policy by  CMS fails to provide a complete picture of the quality of patient care in a particular hospital, according to a new report by Premier.


Although the CMS HACs “are important events to prevent, an exclusive focus on these conditions will miss opportunities to identify and improve care processes for other complications whose elimination could substantially lower mortality, length of stay and costs,” the report’s authors wrote. (Complications Research, a new Premier methodology for identifying hospital-wide harm associated with increased cost, length of stay and mortality in U.S hospitals, Premier Inc.)


Premier identified 86 conditions associated with nearly 50,000 potential deaths, $4.3 billion in costs, and 1.7 million added hospital days. The findings were based on 5.5 million FY13 patient records across 530 hospitals. In comparison, the 22 HACs tracked and penalized by CMS accounted for 1,071 deaths, about $560 million in costs, and 210,000 added hospital days.


The authors and other hospital experts said the hospital conditions identified in the  report could help hospitals evaluate the importance of a particular complication by quantifying the impact against other outcomes. (“Report Urges Wider Hospital-Complication Focus,” HFMA Weekly News, June  13, 2014)


“Studies like this show the potential opportunity hospitals have to improve quality while reducing the cost of care by looking at possible complications beyond those tracked by CMS,” said an HFMA executive. “Where these opportunities are identified, hospitals need to continue improving their complication mitigation efforts rather than wait for any payer’s expansion of penalties tied to those conditions.” (Report Urges Wider Hospital-Complication Focus, HFMA Weekly News, June  13, 2014)


The 10 conditions with the highest association with mortality, cost, and length of stay were:

  • Acute renal failure
  • Hypotension
  • Respiratory failure
  • Sepsis/bacteremia
  • Aspiration pneumonia
  • Acute myocardial infarction (heart attack)
  • Gastrointestinal ulceration and hemorrhage
  • Cerebral infarction
  • Pulmonary embolism
  • Ventilator-associated pneumonia


Those 10 conditions were associated with nearly $2.5 billion in costs, 24,000 potential mortalities, and 920,000 added days in the hospital across approximately 530,000 cases, according to the report.


The Premier report and its methodology can be downloaded by clicking here.



iProtean subscribers, Part Two of the advanced Finance course, Strategic Responses to the Competitive Environment, will be published in your library by the end of June. If you enjoyed Part One, you should look forward to a continuation of the details offered by Michael Irwin and Dan Grauman. Topics include the competitive impact of consolidation/M & A activity, the next phase of mergers and acquisitions, the impact on bond ratings and taxable vs. tax-exempt bonds.


For a complete list of iProtean courses, click here.


For more information about iProtean, click here.