CMS' proposed rule for the hospital inpatient prospective payment system for acute-care hospitals includes proposed measures, scoring and risk adjustment methodology for the Hospital-Acquired Condition Reduction Program.
The HAC Reduction Program, which was established under the Patient Protection and Affordable Care Act, aims to incentivize hospitals to reduce the rate of HACs. Under the proposal, the program would reduce payments 1 percent for acute-care hospitals in the top quartile for HACs for discharges beginning Oct. 1, 2014, and for subsequent program years.
CMS proposed scoring hospitals on their rates of certain HACs to generate a Total HAC Score; the 25 percent of hospitals with the most HACs would receive 99 percent of the payment that would otherwise apply to discharges. CMS proposed eight initial HAC measures that are high volume, high cost and can be prevented by following evidence-based measures.
The measures are separated into two domains that would have equal weight in determining hospitals' Total HAC Score:
Domain 1: Six measures from the Agency for Healthcare Research and Quality
• Pressure ulcer rate
• Volume of foreign object left in the body
• Iatrogenic Pneumothorax rate
• Postoperative physiologic and metabolic derangement rate
• Postoperative pulmonary embolism or deep vein thrombosis rate
• Accidental puncture and laceration rate
Domain 2: Two measures from the Centers for Disease Control and Prevention
• Central line-associated bloodstream infection
• Catheter-associated urinary tract infection
CMS proposed adding surgical site infections for fiscal year 2016 and Methicillin-resistant Staphylococcus aureus Bacteremia and Clostridium difficile infection for FY 2017.
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