BACKGROUND AND PURPOSE:

• The Hospital Acquired Condition Reduction Program (HACRP) was created to incentivize hospitals to reduce hospital-acquired conditions
  • Acute care hospitals that fall in the bottom quarter lose 1% of Medicare payments
• Sankaran et al. (BMJ, 2019) assessed the association between hospital penalization in the HACRP, and impact on clinical outcomes

METHODS:

• Retrospective cohort (Beginning of review and correction period July 23, 2014 through November 30, 2016)
  • Regression discontinuity design, comparing similar hospitals immediately above and below the penalty threshold
  • Data derived from inpatient Medicare claims
  • Acute care hospitals in the US
• Participants
  • Medicare fee-for-service beneficiaries discharged from acute care hospitals
  • ‘Targeted’ acquired condition based on AHRQ Patient Safety Indicator-90 composite (e.g., central line infections, DVT, post-op sepsis etc.)
• Intervention
  • Penalty in the first year of the HACRP: Hospital acquired conditions score ≥7.025 were penalized with a 1% payment reduction  
• Primary outcomes
  • Mean counts of targeted hospital acquired conditions per 1000 care episodes
  • 30-day readmissions
  • 30-day mortality

RESULTS:

• 3,238 acute care hospitals | 708 penalized hospitals included in the study | 15,470,334 discharges (Medicare beneficiaries)
• Mean counts of hospital acquired conditions
  • Penalized hospitals: 2.72 per 1,000 care episodes
  • Non-penalized hospitals: 2.06 per 1,000 care episodes
  • Most common hospital acquired conditions among all study hospitals: Perioperative pulmonary embolism or DVT
• 30-day readmissions
  • Penalized hospitals: 14.4%
  • Non-penalized hospitals: 14.0%
• 30-day mortality was
  • Penalized hospitals: 9.0%
  • Non-penalized hospitals: 9.0%
• Penalized hospitals were more likely to be
  • Large, teaching institutions
  • Greater share of patients with low socioeconomic status
• HACRP penalties were not associated with statistically significant improvements for the following
  • Hospital acquired conditions per 1000 care episodes: −0.16 (95%, CI −0.53 to 0.20)
  • 30-day readmission: −0.36 percentage points (95% CI, −1.06 to 0.33)
  • 30-day mortality: −0.04 percentage points (95% CI, −0.59 to 0.52)

CONCLUSION:

• Based on the study results, HACRP is not associated with clinical improvements
• The authors state that aside from not driving improved care

By disproportionately penalizing hospitals caring for more disadvantaged patients, the HACRP could exacerbate inequities in care

Learn More – Primary Sources:

Changes in hospital safety following penalties in the US Hospital Acquired Condition Reduction Program: retrospective cohort study

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