Are Teaching Hospitals Treated Fairly in the Hospital-Acquired Condition Reduction Program?

Area of Science:

• Healthcare policy and administration
• Hospital quality improvement
• Public health

Background:

• The Hospital-Acquired Condition Reduction Program (HACRP) aims to incentivize hospitals to reduce preventable conditions.
• CMS penalties are applied to hospitals in the lowest quartile of HACRP scores, resulting in a 1% payment reduction.
• Understanding factors associated with HACRP scores and penalties is crucial for improving hospital performance.

Purpose of the Study:

• To identify factors associated with total HACRP scores.
• To determine factors linked to receiving CMS penalties for fiscal years 2015-2017.
• To analyze trends in HACRP scores and penalties over the study period.

Main Methods:

• Analysis of data from 2,249 hospitals for FY2015-2017.
• Evaluation of variables including hospital type, disproportionate patient percentage, case mix index (CMI), number of staffed beds, length of stay (LOS), gross patient revenue, and region.
• Application of multivariate linear and logistic regression models.

Main Results:

• The percentage of hospitals receiving a penalty increased significantly from 21.2% in FY15 to 31.3% in FY17.
• Teaching hospitals, larger hospitals (>400 beds), those with high CMI or long LOS, and hospitals in the Northeast and West were more likely to receive penalties.
• Teaching and larger hospitals showed no improvement in HACRP scores over time compared to nonteaching and smaller hospitals.

Conclusions:

• The current HACRP scoring methodology may require reevaluation.
• CMS could consider stratifying hospitals into homogeneous categories for penalty application.
• Targeted interventions may be needed for specific hospital types and regions to improve performance.