For fiscal year 2016, 758 hospitals were penalized under the hospital-acquired condition (HAC) reduction program. They will have their reimbursement from the Centers for Medicare & Medicaid Services (CMS) reduced by 1 percent for all Medicare discharges between Oct. 1, 2015, and Sept. 30, 2016.
CMS said that approximately 53.7 percent of the hospitals were in the worst performing quartile for fiscal year 2015 and 2016.
The program was created under the Patient Protection and Affordable Care Act and was effective beginning fiscal year 2015, which started with discharges on Oct. 1, 2014.
Under the program, hospitals that are paid under the Inpatient Prospective Payment System are measured on HAC measures. The bottom 25 percent of hospitals could be subject to payment reduction. Hospitals with a total HAC score greater than 6.75 in fiscal year 2016 had their payments reduced.
For fiscal year 2016, the total HAC score was based on four quality measures:
- The Agency for Healthcare Research and Quality Patient Safety Indicator (PSI) 90 Composite, which is a weighted average of the risk- and reliability-adjusted versions of these eight PSIs: pressure ulcer, iatrogenic pneumothorax, central venous catheter-related bloodstream infections, postoperative hip fracture, perioperative pulmonary embolism or deep vein thrombosis, postoperative sepsis, postoperative wound dehiscence and accidental puncture or laceration
- National Healthcare Safety Network (NHSN) Healthcare-Associated Infection (HAI) Central Line-Associated Bloodstream Infection
- NHSN HAI Catheter-Associated Urinary Tract Infection
- NHSN HAI Surgical Site Infection – colon and hysterectomy
As part of the HAC reduction program, CMS publishes the Hospital Compare data on its website.
CMS said 3,308 hospitals were subject to the program for fiscal year 2016 and that the program will save $364 million through the penalties.
CMS added that 22.9 percent of hospitals in fiscal year 2016 were penalized, up from 21.9 percent of hospitals in 2015.