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Are Teaching Hospitals Treated Fairly in the Hospital-Acquired Condition Reduction Program?
Mayar Al Mohajer1, Keith A Joiner, David E Nix
1M. Al Mohajer is associate professor of medicine, Department of Medicine, Baylor College of Medicine, Houston, Texas. K.A. Joiner is professor of medicine and economics, Center for Management Innovations in Health Care, Eller College of Management, University of Arizona, Tucson, Arizona. D.E. Nix is professor of pharmacy, Department of Pharmacy Science and Practices, University of Arizona, Tucson, Arizona.
Insights
Hospitals receiving penalties from the Centers for Medicare and Medicaid Services (CMS) increased from 2015 to 2017. Teaching hospitals and larger facilities were more likely to be penalized, with no improvement over time.
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.
Purpose:
To identify the factors associated with total Hospital-Acquired Condition Reduction Program (HACRP) score and with receiving a Centers for Medicare and Medicaid Services (CMS) penalty (1% reduction in payment to those hospitals in the lowest-performing quartile of HACRP scores) for fiscal years (FYs) 2015-2017 with a particular focus on trends over this period.
Method:
The authors evaluated the following variables: (1) type of hospital (teaching vs. nonteaching); (2) disproportionate patient percentage; (3) case mix index (CMI); (4) number of staffed beds; (5) length of stay (LOS); (6) gross patient revenue; and (7) region, using data from CMS and the American Hospital Directory. They conducted multivariate linear and logistic regressions.
Results:
A total of 2,249 hospitals were included. The mean total HACRP scores across hospitals for FY15, FY16, and FY17 were 5.38, 5.35, and 5.18, respectively. In FY15, 21.2% (476/2,249) of hospitals received a penalty compared with 22.6% (508/2,249) in FY16 and 31.3% (704/2,249) in FY17 (P < .001). The logistic regression model showed that teaching hospitals, larger hospitals (> 400 beds), hospitals with high CMI or long LOS, and hospitals in the Northeast and Western United States were more likely to receive a penalty. Teaching hospitals and larger hospitals did not improve their scores over time compared with nonteaching and small hospitals.
Conclusions:
A reevaluation of the scoring methodology for the HACRP is needed. CMS could stratify hospitals into homogeneous categories and apply penalties to those that have the worst scores in each category.
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