Measurement matters: changing penalty calculations under the hospital acquired condition reduction program (HACRP) cost hospitals millions

Abstract

Background 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. 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. Methods We 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. Results Comparing 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. Conclusions HACRP 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.

Combined impact of Medicare’s hospital pay for performance programs on quality and safety outcomes is mixed

“…Our previous research also suggests that metrics employed by Medicare’s P4P programs may be hard for hospitals to target because they are noisy (i.e. driven by random variation) [ 23 ] or updated too frequently to allow hospitals to effectively respond [ 24 ]. Whatever the root cause, our results are consistent with previous studies of Medicare P4P programs that find minimal, if any, impact on mortality [ 25 , 26 ].…”

The association of acute COVID‐19 infection with Patient Safety Indicator‐12 events in a multisite healthcare system

“…Holding hospitals liable for unavoidable VTEs in COVID-19 patients may lead to penalties against tertiary and academic facilities caring for large volumes of the sickest patients. 26…”

“…They found improvement in PSI‐90 for hospitals that were larger, were major teaching centers, had greater diagnostic resources, or cared for sicker patients. Holding hospitals liable for unavoidable VTEs in COVID‐19 patients may lead to penalties against tertiary and academic facilities caring for large volumes of the sickest patients 26 . This may have the unintended outcome of lower‐quality care being provided to COVID‐19 patients who need urgent surgical procedures by facilities concerned about public reporting and federal pay‐for‐performance consequences surrounding such measures.…”

Caracterização dos óbitos notificados decorrentes de complicações dos cuidados médicos e cirúrgicos

“…18 Embora a maioria dessas mortes possam estar associadas à maior vulnerabilidade dessa população, seja pela idade avançada ou pelas comorbidades apresentadas por esses indivíduos, infere-se que a qualidade do cuidado ofertado na tríade estrutura, processos e resultados possa ter contribuído para o desfecho fatal desses casos. 19 As variações observadas em relação ao número de mortes e de suas respectivas causas na presente pesquisa, que somadas às características demográficas, epidemiológicas e das disparidades regionais em recursos financeiros, humanos e materiais para assistência hospitalar, 20 explicam as semelhanças, ou não, acerca dos óbitos notificados entre as cinco macrorregiões brasileiras.…”