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CMS-1403-FC
admission. That is, the case will be paid as though the
secondary diagnosis related to the HAC was not present.
Medicare will continue to assign a discharge to a higher
paying Medicare Severity-Diagnosis Related Group (MS-DRG)
if a selected condition was present on admission.
The broad principle articulated in the HAC payment
provision for IPPS hospitals (that is, Medicare not paying
more for certain reasonably preventable hospital-acquired
conditions) could potentially be applied to other Medicare
payment systems for conditions that occur in settings other
than IPPS hospitals. Other possible settings of care
include, but are not limited to: hospital outpatient
departments, ambulatory surgical centers, SNFs, HHAs, ESRD
facilities, and physician practices. Implementation would
be different for each setting, as each payment system is
different and the level of reasonable prevention through
the application of evidence-based guidelines would vary for
candidate conditions across different settings of care.
However, alignment of incentives across settings of care is
an important goal for all of our VBP initiatives, including
the HAC payment provision.
A related application of the broad principle behind
the HAC payment provision for IPPS hospitals could be
considered through Medicare secondary payer policy by
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