CMS Penalizes 758 Hospitals Over Hospital-Acquired Conditions
The program, created under the Affordable Care Act, aims to help the federal government move toward value-based care by evaluating hospitals on various quality measures. Hospitals that perform in the bottom quartile of those measures receive a 1% reduction in Medicare payments.
CMS has completed two rounds of assessments under the program. CMS evaluated 3,308 hospitals during its latest round. The agency based hospitals' performance scores on measures of:
- Bloodstream infections in patients with central lines;
- Surgical-site infections; and
- Urinary tract infections for catheterized patients (Evans, Modern Healthcare, 12/10).
In addition, CMS evaluated the hospitals on a composite score of eight quality measures based on treatment complications, including rates of:
- Collapsed lungs;
- Broken hips;
- Infections from colon operations;
- Infections from hysterectomies (Rau, Kaiser Health News, 12/10);
- Pressure ulcers (Modern Healthcare, 12/10);
- Reopened wounds (Kaiser Health News, 12/10);
- Sepsis (Modern Healthcare, 12/10); and
- Surgical tears (Kaiser Health News, 12/10).
The payment reductions took effect on Oct. 1, the start of the federal fiscal year. The reductions remain in effect for one year. According to Modern Healthcare, Medicare is expected to spend $364 million less on hospitals because of the reductions (Modern Healthcare, 12/10).
CMS reduced payment rates for about one in six hospitals. According to KHN, Congress exempted critical access hospitals, children's hospitals and veterans hospitals from the program.
In California, 88 hospitals will are being penalized in FY 2016 over their hospital-acquired condition rates. Of those, 51 also were penalized for in FY 2015 (Kaiser Health News, 12/10).
According to CMS, 54% of hospitals that are being penalized in this round of evaluations were also penalized in the last round (Modern Healthcare, 12/10). Overall, 407 hospitals ranked in the bottom performance quartile in both evaluation rounds (Kaiser Health News, 12/10).
Meanwhile, CMS noted that average hospital performance nationwide improved on two of the program's three quality measures:
- Average score for composite index; and
- Central-line associated bloodstream infections.
However, average hospital performance nationwide declined on catheter-associated urinary tract infections, according to CMS.
Still, CMS Deputy Administrator and CMO Patrick Conway noted that about 50% of hospitals had moved out of the bottom performance quarter in the second round of assessments.
Critics Debate Program's Effectiveness
Some stakeholders have claimed the program disproportionately affects hospitals with low-income and sicker patient populations. Ashish Jha, a health policy professor at Harvard University, noted that large hospitals and academic institutions that provide care for a majority of sicker and lower-income patients will continue to face penalties until the program does more to account for factors specific to such patient populations (Modern Healthcare, 12/10).
In addition, some hospitals have said the penalties are unfairly imposed on hospitals that have made progress but have not yet caught up with other facilities.
Mark Jarrett, chief quality officer for the North Shore-LIJ Health System, said, "What bothers me the most is when people are improving and get that penalty, that's money that could be invested into better care."
Meanwhile, some patient safety advocates have said the program's penalties are too small to truly compel hospitals to improve quality (Kaiser Health News, 12/10).This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.