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Pinson and Tang CDI Pocket Guide
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The Hospital Acquired Condition Reduction Program

July 7, 2014

This is the second of a series of articles on how CDI Programs can contribute to their organization's success under CMS P4P metrics.

Most CDI Teams are surprised to learn that the new CMS Hospital Acquired Condition Reduction Program (HACRP) is different from and in addition to the 2008 Deficit Reduction Act HAC program for MCC/CC payment exclusion which still continues. Starting October 1, 2014, 25% of the weakest performing hospitals will have their Medicare pay docked by 1 percent under HACRP.

HACRP Program Measures

There are two categories, or "Domains", of measures included in the HACRP. Domain 1 is a claims-based composite measure referred to as Patient Safety Indicator (PSI) #90 derived from ICD-9-CM codes (see Table 1). Domain 2 is not claims-based but rather clinically abstracted by individuals and reported to the CDC for CLABSI (central line associated blood stream infection) and CAUTI (catheter-associated UTI) rates.

Performance is weighted 35% for Domain 1 (PSI #90) and 65% for Domain 2.; Not only does PSI #90 performance impact the HACRP, it is also included in the Hospital Value Based Purchasing Program (HVBP).

Table 1 - PSI #90 Composite Measures

Pressure Ulcer Post-op Hip Fracture
Iatrogenic Pneumothorax Post-op Sepsis
CLABSI Post-op Wound Dehiscence
Accidental Surgical Puncture/Laceration Perioperative PE or DVT

Your CDI Program and HACRP

CDI Programs are uniquely positioned to measure, monitor and improve the quality of medical record documentation and resulting ICD-9-CM code assignment. Understanding the impact of HACRP and other quality metrics allows documentation specialists to clarify diagnoses and conditions affecting these measures for correct coding and for clinical abstraction by quality nurses.

As examples, post-op hip fractures specified as osteoporotic are excluded from PSI #90; "unstagable" pressure ulcers are included, so stage should always be documented. Documentation of POA status for CLABSI and CAUTI is crucial for correct abstraction and coding.

HCQ Consulting Can Help

We at HCQ Consulting can provide your CDI program with assessment, education and process development to incorporate hospital and physician quality performance measures like HACRP, value based purchasing and readmission reduction into your program. Please contact us for more information.

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