Becker's Clinical Quality & Infection Control

8 Patient Safety I n fiscal 2015, 721 hospitals will have their Medicare payments reduced for being among the 25 percent of hospitals with the highest rates of hospital-acquired conditions. Here are 15 things to know about the HAC Reduc- tion Program and the hospitals receiving penalties. 1. The HAC Reduction Program, created under the Patient Protection and Affordable Care Act, is aimed at reducing preventable harm to patients by penalizing the 25 percent of hospitals with the highest rates of HACs. These facilities will have their payments reduced by 1 percent for all dis- charges occurring after Oct. 1, 2014. 2. The HAC reduction is made after adjustments are made for the Value-Based Purchasing Pro- gram. 3. The penalties for the 721 hospitals total $373 million, according to Kaiser Health News. 4. These penalties aren't the first hospitals have gotten from Medicare in 2014. Medicare also pe- nalized 2,610 hospitals for high readmission rates this year under the Hospital Readmissions Reduc- tion Program. Those hospitals will receive lower payments for every Medicare patient stay from Oct. 1 to Sept. 30, 2015. 5. The HACs looked at for the program are speci- fied by CMS each year and include a group of rea- sonably preventable conditions, including infec- tions that patients did not have upon admission and developed during the hospital stay. 6. The HAC program has three measures for FY 2015: Patient Safety Indicator 90 composite, cen- tral line-associated bloodstream infections and catheter-associated urinary tract infections. 7. About 1,400 hospitals, such as psychiatry and rehabilitation hospitals, are exempt from pro- gram penalties because of the type of treatment they provide. Additionally, critical access hospitals and hospitals in Maryland are exempt. 8. Each hospital in the HAC Reduction Program receives a score of one to 10 points based on its national ranking, with a lower score being better. For fiscal 2015, the 25 percent of hospitals receiv- ing penalties had total scores above seven. 9. Of the 721 hospitals receiving penalties, more than 90 had a score of nine or higher. 10. There are 143 major teaching hospitals, in- cluding Grady Memorial Hospital in Atlanta and Northwestern Memorial Hospital in Chicago, re- ceiving penalties, according to Kaiser Health News. 11. Some renowned hospitals were included on the list of those receiving penalties, including Cleveland Clinic and Geisinger Medical Center in Danville, Pa. 12. Although the government took into account the specific demographics of patients at hospital when judging complications, academic medical centers feel the adjustments are insufficient due to the types of care they provide and the types of cases they handle, according to Kaiser Health News. 13. California has more hospitals than any other state, and it is also home to the most hospitals re- ceiving penalties. 14. No hospitals in Vermont or Hawaii were pe- nalized. 15. On Dec. 18, 2014, the American Hospital As- sociation sent a letter to the Director of the Quality Measurement and Health Assessment Group, pro- viding comment on the reevaluation of the HAC program scoring methodology. In it's letter, the AHA strongly urged CMS "to address other more significant and meaningful issues in the HAC pro- gram" going forward, including supporting "in- novative approaches to measuring patient safety events" such as hospitals "developing all-cause pa- tient harm measures derived from EHRs." n I n fiscal year 2015, 721 hospitals will have their Medicare payments re- duced as part of the Hospital-Acquired Conditions Reduction Program because they are among the 25 percent of hospitals with the highest rates of HACs. Hospitals in nearly every state* faced fines, but some states had a higher per- centage of hospitals penalized than others. The 10 states listed below had the highest percentage of hospitals fined by Medicare for high HAC rates. 1. Utah — 44.4 percent of hospitals faced fines (16 hospitals) 2. Connecticut — 41.2 percent (14 hospitals) 3. Rhode Island — 33.3 percent (4 hospitals) 4. Nevada — 32.1 percent (9 hospitals) 5. New Jersey — 30.7 percent (23 hospitals) 6. Colorado — 28.3 percent (15 hospitals) 7. New Mexico — 27.5 percent (11 hospitals) 8. Maine — 27.3 percent (6 hospitals) 9. Washington — 26.6 percent (17 hospitals) 10. Georgia — 25.2 percent (29 hospitals) * No hospitals in Vermont or Hawaii were penalized. Hospitals in Maryland were exempt from the fines due to the state's special payment arrangement with the federal government. n Editor's note: Percentages were calculated using the number of hospitals fined by Medicare and the number of hospitals in each state, according to the American Hospital Directory. 721 Hospitals Penalized by Medicare for High Hospital-Acquired Condition Rates By Ayla Ellison and Kelly Gooch 10 States Hit Hardest by Medicare Hospital Infection Fines By Shannon Barnet

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