The Cost Impact of Hospital-Acquired Conditions Among Critical Care Patients

Background: The modifications introduced to the inpatient prospective payment system on October 1, 2008, to disallow payment for 8 secondary conditions, if not present on admission (POA), constitute a significant shift that is expected to be followed by similar steps by private payers. Objective: To investigate the cost impact of hospital-acquired complications (HACs). Research Design: Discharges that included critical care (CC) stay cases, stratified by diagnosis-related groups, were categorized into (1) cases with HACs-those cases where 1 or more of complications were acquired during the course of treatment; (2) cases with complications that were POA; and (3) cases with no HACs or complications on admission. Twelve diagnostic condition groupings or HACs were examined. Results: Sepsis was the most common condition among single-occurrence HACs, as well as those where 2 HACs occurred. Among the 22 diagnosis-related groups examined, total discharge and CC costs, length of stay, and CC length of stay were consistently the highest among discharges where a HAC occurred, followed by discharges with the presence of a POA complication. Conversely, the lowest level of resource use was associated with discharges where no complication occurred. Conclusions: The estimates provided in this study should enable hospitals to identify how improvements in care can also result in cost savings. Focusing this study on CC cases enables hospitals to address highest cost cases that consume crucial resources in their CC settings.