The Hospital-Acquired Condition Reduction Program may not accurately measure quality or fairly penalize hospitals, according to a study published in JAMA.
Researchers from the Feinberg School of Medicine at Northwestern University in Chicago examined the characteristics and performance of the 721 hospitals penalized under the HAC program in fiscal year 2015. They looked at data from CMS' Hospital Compare site as well as from the 2014 American Hospital Association Annual Survey and the FY2015 Medicare Impact File.
They created an eight-point hospital quality score that incorporated hospital characteristics related to clinical volume, accreditations and advanced care services offerings, as well as process of care and outcomes measures.
Researchers found that some subsets of hospitals were more likely to be penalized than others. See below:
Joint Commission accreditation status
- 24 percent of hospitals with Joint Commission accreditation were penalized
- 14 percent of non-Joint Commission accredited hospitals were penalized
Teaching status
- 42 percent of major teaching hospitals were penalized
- 62 percent of very major teaching hospitals were penalized
- 17 percent of nonteaching hospitals were penalized
Safety-net status
- 28 percent of safety-net hospitals were penalized
- 20 percent of non-safety-net hospitals were penalized
Additionally, hospitals with an eight on the eight-point scale were penalized much more often than hospitals with a score of zero: Of the 55 hospitals with an eight, 37 were penalized (67 percent) while of the 422 with a score of zero, just 53 got penalized (13 percent).
The study's authors concluded that "these paradoxical findings suggest that the approach for assessing hospital penalties in the HAC Reduction Program merits reconsideration to ensure it is achieving the intended goals."