Medicare's policy not to pay for treating hospital-acquired conditions: the impact

Health Aff (Millwood). 2009 Sep-Oct;28(5):1485-93. doi: 10.1377/hlthaff.28.5.1485.


In 2008 Medicare stopped reimbursing hospitals for treating eight avoidable hospital-acquired conditions. Using 2006 California data, we modeled the financial impact of this policy on six such conditions. Hospital-acquired conditions were present in 0.11 percent of acute inpatient Medicare discharges; only 3 percent of these were affected by the policy. Payment reductions were negligible (0.001 percent, or $0.1 million-equivalent to $1.1 million nationwide) and are unlikely to encourage providers to improve quality. Options to strengthen the incentives include further payment modifications for hospital-acquired conditions or expanding the hospital-acquired condition policy to exclude payment for consequences, additional procedures, and readmissions.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • California
  • Centers for Medicare and Medicaid Services, U.S.
  • Cross Infection / economics*
  • Health Policy*
  • Humans
  • Medicare / economics*
  • Medicare / legislation & jurisprudence
  • Patient Discharge
  • Reimbursement Mechanisms / legislation & jurisprudence*
  • United States