Medicare will likely update measures for hospital-acquired conditions

In the wake of recent research that revealed a flaw in how Medicare measures reductions in hospital-acquired conditions (HACs), the Centers for Medicare & Medicaid Services plans to update and expand the methodology it uses to calculate the benchmarks.

The changes are outlined in a new policy brief from Health Affairs and the Robert Wood Johnson Foundation that examines the concerns raised about the federal HAC Reduction Program and what the future holds for it.

The program, established under the Affordable Care Act, aims to decrease preventable conditions such as pressure ulcers and adverse drug events by reducing payments to low-performing hospitals. HACs can result in longer hospital stays, permanent harm to patients and death. The costs to treat them are also high: medical care for a surgical-site infection can run as much as $21,000, according to The Agency for Healthcare Research and Quality.

About 1 in 5 hospitals that participate in the HAC program received penalties in fiscal year 2015, FierceHealthcare previously reported.

Hospitals have expressed concerns about the design of the program and how CMS implemented it. For example, the policy brief notes, the law requires Medicare to issue penalties to the lowest-performing hospitals, even if they have improved their performance. The measures used also overlap with one another and with other quality programs. As a result, hospitals can face multiple penalties for the same incident.

Other complaints include one of the claims-based measures for the program, PSI-90, which hospitals say isn't statistically reliable or found in a data source consistently across organizations. In addition, the policy brief notes, hospitals argue that the claims-based measures don't fully reflect the patient's clinical history or the quality of care provided.

CMS doesn't intend to back down on the HAC program, but does plan to increase the number of measures it uses from the National Healthcare Safety Network (NHSN) and also use measures that more hospitals may report, according to the brief. Current measures are specific to intensive care units but in the future CMS will expand the scope to include additional locations within the hospital.

In addition, the Centers for Disease Control and Prevention is updating the assumptions used in calculating the NHSN measures, and the National Quality Forum is reviewing the components and weight of the PSI-90 measure, according to the brief.

To learn more:
- here's the brief
- check out the AHRQ statistics

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