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Changes in Hospital-acquired Conditions and Mortality Associated With the Hospital-acquired Condition Reduction
Emily Arntson1,2,3, Justin B Dimick1,4,5, Ushapoorna Nuliyalu4,5,3
1University of Michigan Medical School, Ann Arbor, Michigan.
Insights
The Hospital-Acquired Condition Reduction Program (HACRP) successfully reduced hospital-acquired conditions (HACs) in Medicare patients. However, the program did not significantly impact 30-day mortality rates for surgical patients.
Area of Science:
- Health Policy
- Patient Safety
- Healthcare Quality Improvement
Background:
- The Centers for Medicare and Medicaid Services implemented the Hospital-Acquired Condition Reduction Program (HACRP) in 2013 to enhance patient safety.
- This program financially incentivizes hospitals to reduce hospital-acquired conditions (HACs) by adjusting Medicare payments.
Purpose of the Study:
- To assess the impact of the HACRP announcement on the incidence of HACs.
- To evaluate the effect of the HACRP on 30-day mortality rates among surgical patients.
Main Methods:
- Utilized an interrupted time-series design analyzing Medicare Provider and Analysis Review (MEDPAR) claims data from 2009-2015.
- Employed linear spline models to detect changes in HACs and mortality rates before and after the Affordable Care Act (ACA) and HACRP implementation.
Main Results:
- Hospital-acquired conditions saw a significant decline following the HACRP announcement, with an adjusted annual slope difference of -1.34 per 1000 discharges.
- While 30-day mortality rates decreased after the ACA, they remained stable after the HACRP announcement, showing an adjusted annual slope of -0.01.
Conclusions:
- The HACRP effectively contributed to the reduction of targeted hospital-acquired conditions.
- Despite reductions in HACs, the HACRP did not demonstrate a significant effect on improving 30-day mortality rates for Medicare beneficiaries undergoing surgery.
Importance:
To improve patient safety, the Centers for Medicare and Medicaid Services announced the Hospital-Acquired Condition Reduction Program (HACRP) in August 2013. The program reduces Medicare payments by 1% for hospitals in the lowest performance quartile related to hospital-acquired conditions. Performance measures are focused on perioperative care.
Objective:
To evaluate changes in HACs and 30-day mortality after the announcement of the HACRP.
Design:
Interrupted time-series design using Medicare Provider and Analysis Review (MEDPAR) claims data. We estimated models with linear splines to test for changes in HACs and 30-day mortality before the Affordable Care Act (ACA), after the ACA, and after the HACRP.
Setting:
Fee-for-service Medicare 2009-2015.
Participants:
Medicare beneficiaries undergoing surgery and discharged from an acute care hospital between January 2009 and August 2015 (N = 8,857,877).
Main Outcome And Measure:
Changes in HACs and 30-day mortality after the announcement of the HACRP.
Results:
Patients experienced HACs at a rate of 13.39 per 1000 discharges [95% confidence interval (CI), 13.10 to 13.68] in the pre-ACA period. This declined after the ACA was passed and declined further after the HACRP announcement [adjusted difference in annual slope, -1.34 (95% CI, -1.64 to -1.04)]. Adjusted 30-day mortality was 3.69 (95% CI, 3.64 to 3.74) in the pre-ACA period among patients receiving surgery. Thirty-day mortality continued to decline after the ACA [adjusted annual slope -0.04 (95% CI, -0.05 to -0.02)] but was flat after the HACRP [adjusted annual slope -0.01 (95% CI, -0.04 to 0.02)].
Conclusions And Relevance:
Although hospital-acquired conditions targeted under the HACRP declined at a greater rate after the program was announced, 30-day mortality was unchanged.
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