Updates on Medicare penalties for hospital-acquired conditions

Updates on Medicare penalties for hospital-acquired conditions


There is at least one incident of a health care-associated condition in one in 25 hospitals across the country every day, according to the Centers for Disease Control and Prevention. With financial penalties for hospital-acquired conditions a serious reality, medical facilities are under pressure to provide top-quality care. In 2017, several hundred hospitals were hit with the penalty, despite controversy among health care professionals over the fairness and accuracy of the punishment.

Penalties from the Hospital-Acquired Condition Reduction Program
To hold hospitals accountable for the avoidable conditions patients develop in a hospital or medical facility while receiving treatments, therapies or procedures, former President Barack Obama's health care law enacted the Hospital-Acquired Condition Reduction Program. With increasing rates of patient safety, the program has seen relative success in improving quality care across the nation. The HACRP is most concerned with easily preventable HACs, which include:

  • Infections.
  • Pneumonia.
  • Falls.
  • Hip fractures.
  • Blood clots.
  • Burns.
  • Bedsores.
  • Pressure ulcers.
  • Blood mismatch.
  • Surgical mishaps.
  • Post-surgery wound ruptures.

In 2014, the program enacted penalties in an effort to reduce the frequency of these preventable issues. They require the Centers for Medicare and Medicaid to rank all hospitals on HAC rates and reduce payments to the lowest-performing 25 percent of facilities. To calculate the total HAC score, Medicare evaluates certain quality measures, which cover patient safety indicators; MRSA; and bloodstream, urinary tract, surgical site and Clostridium difficile infections. As required by the health care law, Medicare will then reduce hospital payments by one percent for those that rank among the lowest-performing 25 percent.

Female nurse helping patient walkMedicare penalized 751 hospitals for high rates of hospital-acquired conditions in 2017.

The numbers are in
In 2017, CMS penalized 751 of the 3,306 facilities evaluated for HACs. The hardest-hit states were Connecticut and Delaware, where half of the evaluated hospitals were penalized. Every state except Maryland had at least one hospital suffer the penalty.

Controversy in the industry
While the HACRP has encouraged medical facilities to increase the quality of their patient care, many health care professionals have highlighted concerns with the program. For instance, specialty hospitals are exempt from penalties, but academic medical centers are not. These teaching hospitals often receive an unfair penalty due to their high volume of testing and treating infections. The American Hospital Association and KNG Health Consulting conducted a study to prove biases in the program and concluded that hospitals on either end of the size spectrum are unfairly punished. Plus, many hospitals will always struggle to escape the low ranking, even if they've reduced the number of avoidable patient infections and injuries in their facilities. Health care professionals and organizations continue to urge re-evaluations for more accurate ranking measures that recognize improvement efforts.

The results of 2017 didn't help convince those who were already concerned about fairness, as CMS and CDC revealed a programming error that wasn't corrected until after hospital performance reports were already published. Thus, while many health care organizations support efforts to increase quality in patient care, there are still flaws to address in the HACRP process.

"We want to get out of the penalty zone."

How to avoid HACs
With the penalties in place, hospitals should implement efforts to increase the quality of their care. Dr. Amy Boutwell, a quality-improvement consultant in Massachusetts, told National Public Radio that she's heard hospitals worry about the rankings:

"We don't want to be in the lowest quartile; we want to get out of the penalty zone,"she said.

To prevent avoidable HACs, Becker's Clinical Leadership and Infection Control suggested standardizing electronic health record systems and clinical language for better communication and data reporting regarding patient health. It's also important to have a staff that's committed to continuously improving the hospital's systems and safety. Make sure staff are aware of previous mishaps, and educate them on how to avoid future mistakes.

Certain HACs, especially surgical site infections, can be prevented by using disposable medical tools. OBP Medical is the leading provider of single-use, self-contained devices, complete with LED lighting for improved visibility during procedures. These innovative products reduce the unnecessary risk of cross contamination that can lead to HACs. Learn more about which products are available, and request a free sample today.