Rajaram R, Chung JW, Kinnier CV, Barnard C, Mohanty S, Pavey ES…, Bilimoria KY.

JAMA. 2015 Jul 28;314(4):375-83.

2015

Hospital

Hospital (HAP)

Not applicable

No

To examine the characteristics of hospitals penalized by the Hospital-Acquired Condition (HAC) Reduction Program, and to evaluate the association of a summary score of hospital characteristics related to quality with penalization in the HAC program.

Cross-Sectional Study

Data for hospitals participating in the FY2015 Hospital-Acquired Condition (HAC) Reduction Program were obtained from Centers for Medicare and Medicaid Services' (CMS) Hospital Compare and merged with the 2014 American Hospital Association Annual Survey and FY2015 Medicare Impact File. Logistic regression models were developed to examine the association between hospital characteristics and HAC program penalization. An eight-point hospital quality summary score was created using hospital characteristics related to volume, accreditation, and offering of advanced care services. The relationship between the hospital quality summary score and HAC program penalization was examined. Publicly reported process-of-care and outcome measures were examined from four clinical areas (surgery, acute myocardial infarction, heart failure, pneumonia), and their association with the hospital quality summary score was evaluated.

Of the 3284 hospitals participating in the Hospital-Acquired Condition (HAC) program, 721 (22.0%) were penalized. Hospitals were more likely to be penalized if they were: major teaching hospitals (42.3%; OR, 1.58; 95% CI, 1.09-2.29) or very major teaching hospitals (62.2%; OR, 2.61; 95% CI, 1.55-4.39; vs non-teaching hospitals, 17.0%); they cared for more complex patient populations based on case mix index (quartile four vs quartile one: 32.8% vs 12.1%; OR, 1.98; 95% CI, 1.44-2.71); they were accredited by the Joint Commission (24.0% accredited, 14.4% not accredited; odds ratio [OR], 1.33; 95% CI, 1.04-1.70); or they were safety-net hospitals vs non-safety-net hospitals (28.3% vs 19.9%; OR, 1.36; 95% CI, 1.11-1.68). Hospitals with higher hospital quality summary scores had significantly better performance on 9 of 10 publicly reported process and outcomes measures compared with hospitals that had lower quality scores (all P ≤ .01 for trend). However, hospitals with the highest quality score of 8 were penalized significantly more frequently than hospitals with the lowest quality score of 0 (67.3% [37/55] vs 12.6% [53/422]; P < .001 for trend). Among hospitals participating in the HAC Reduction Program, hospitals that were penalized more frequently had more quality accreditation's, offered advanced services, were major teaching institutions, and had better performance on other process and outcome measures. These paradoxical findings suggest that the approach for assessing hospital penalties in the HAC Reduction Program merits reconsideration to ensure it is achieving the intended goals.

2014

http://www.ncbi.nlm.nih.gov/pubmed/26219055

HAC reduction program, accreditation, hospital penalties, hospitals

Negative