CMS program to reduce hospital-acquired conditions has flaws

The Medicare program that penalizes hospitals financially for failing to adequately reduce hospital-acquired conditions (HACs) might be backfiring, a new study published in JAMA suggests.

The hospitals penalized most frequently "had more quality accreditations, offered advanced services, were major teaching institutions, and had better performance on other process and outcome measures," according to the study abstract, which called the findings "paradoxical."

"These findings suggest that penalization in this program may not reflect poor quality of care but rather may be due to measurement and validity issues of the HAC program component measures," according to a study announcement.

Researchers from the Feinberg School of Medicine at Chicago's Northwestern University looked at hospitals penalized in fiscal 2015 under the HAC Reduction Program established under the Affordable Care Act, 1 in 5 hospitals participating in the HAC program were penalized. They also found that hospitals with the highest quality summary scores were penalized much more often (67 percent) than hospitals with the lowest quality scores (13 percent).

"Hospitals that look for more adverse events frequently identify more events and incorrectly appear to have worse performance," the announcement said. The researchers also suspected that hospitals with better information technology might be more able to detect adverse events.

The Centers for Medicaid & Medicare Services (CMS), which administers the HAC Reduction Program, says its methodology was approved by the National Quality Forum, Scripps News reported.

In the program's first year, CMS penalized 721 hospitals by withholding 1 percent of their Medicare reimbursement, according to the article.

"I think an important message to note is that while there are many of these larger hospitals that do fall into the group of hospitals that might be subject to payment penalties, there are also some very large hospitals with extremely low infection rates and large teaching hospitals with very good infections rates," Arjun Srinivasan, associate director for healthcare-associated infection programs at the Centers for Disease Control and Prevention, told Scripps News.

Other research has interpreted the penalties as showing that hospitals with limited resources were able to make a bigger dent in lowering the rate of hospital-acquired infections.

Hospitals knew last year that they would likely face significant penalties under the HAC program. Hospitals in South Florida alone faced $330 million in penalties, according to reports. In Texas, most of the hospitals being penalized were centered in the state's biggest cities.

For more:
- here's the abstract
- see the study announcement
- check out the Scripps News report
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