Abstract
BackgroundSince October 2014, the Centers for Medicare and Medicaid Services has penalized 25% of U.S. hospitals with the highest rates of hospital-acquired conditions under the Hospital Acquired Conditions Reduction Program (HACRP). While early evaluations of the HACRP program reported cumulative reductions in hospital-acquired conditions, more recent studies have not found a clear association between receipt of the HACRP penalty and hospital quality of care. We posit that some of this disconnect may be driven by frequent scoring updates. The sensitivity of the HACRP penalties to updates in the program’s scoring methodology has not been independently evaluated.MethodsWe used hospital discharge records from 14 states to evaluate the association between changes in HACRP scoring methodology and corresponding shifts in penalty status. To isolate the impact of changes in scoring methods over time, we used FY2018 hospital performance data to calculate total HAC scores using FY2015 through FY2018 CMS scoring methodologies.ResultsComparing hospital penalty status based on various HACRP scoring methodologies over time, we found a significant overlap between penalized hospitals when using FY 2015 and 2016 scoring methodologies (95%) and between FY 2017 and 2018 methodologies (46%), but substantial differences across early vs later years. Only 15% of hospitals were eligible for penalties across all four years. We also found significant changes in a hospital’s (relative) ranking across the various years, indicating that shifts in penalty status were not driven by small changes in HAC scores clustered around the penalty threshold.ConclusionsHACRP penalties have been highly sensitive to program updates, which are generally announced after performance periods are concluded. This disconnect between performance and penalties calls into question the ability of the HACRP to improve patient safety as intended.
Highlights
Since October 2014, the Centers for Medicare and Medicaid Services has penalized 25% of U.S hospitals with the highest rates of hospital-acquired conditions under the Hospital Acquired Conditions Reduction Program (HACRP)
Since October 2014, the Centers for Medicare and Medicaid Services (CMS), under the Hospital-Acquired Condition Reduction Program (HACRP), has penalized hospitals in the worst performing quartile of Hospital-acquired conditions (HAC) quality measures; that is, hospitals with a total HAC score above the 75th percentile are subject to a one percent penalty on their Medicare revenues, assessed when CMS pays a claim
Using Medicare hospital discharge and National Healthcare Safety Network (NHSN) data for hospitals in 14 states, and HACRP scoring methodologies for fiscal years (FYs) 2015-2018, we examined the impact of the changing HACRP scoring algorithms on hospital penalty status
Summary
Since October 2014, the Centers for Medicare and Medicaid Services has penalized 25% of U.S hospitals with the highest rates of hospital-acquired conditions under the Hospital Acquired Conditions Reduction Program (HACRP). While early evaluations of the HACRP program reported cumulative reductions in hospital-acquired conditions, more recent studies have not found a clear association between receipt of the HACRP penalty and hospital quality of care. Since October 2014, the Centers for Medicare and Medicaid Services (CMS), under the Hospital-Acquired Condition Reduction Program (HACRP), has penalized hospitals in the worst performing quartile of HAC quality measures; that is, hospitals with a total HAC score above the 75th percentile are subject to a one percent penalty on their Medicare revenues, assessed when CMS pays a claim. While early evaluations of HACRP reported cumulative reductions in hospital-acquired conditions [1, 2], more recent studies [3,4,5,6,7] have not found a clear association between receipt of the HACRP penalty and hospital quality of care. Other research found that under HACRP, CMS assigned different scores to hospitals whose performance was statistically the same and penalized 25% of hospitals regardless of the statistical significance of the difference between their performance and others [4]
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