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The top 10 strategies an organization can use to maximize performance on the prevention of hospital-acquired conditions
See how you score on these HAC quiz questions
In December, the Centers for Medicare and Medicaid Services (CMS) reported that 758 hospitals are subject to a 1% payment reduction applied to all Medicare discharges between October 1, 2015 and September 30, 2016 as part of the Hospital-Acquired Condition (HAC) Program. A HAC is an undesirable medical condition or complication a patient develops during a hospital stay. Penalized hospitals make up approximately 23% of the 3,308 participating in the HAC Program. The number of hospitals receiving a payment reduction in FY 2016 increased by 34 from the previous year.
Although a 1% reduction in Medicare reimbursement may not sound like much, it could make a significant difference in a hospital’s ability to survive in today’s highly competitive market with shrinking margins. For example, if a hospital’s annual patient revenue is $1.5 billion and about 25% comes from CMS reimbursement, that’s $375 million. A 10% penalty is $37.5 million. These are dollars an organization needs for things like facility improvements, staff salaries and benefits, and equipment.
The CMS HAC Program calculates payment adjustments by collecting measures from hospitals in two domains. Domain 1 is a composite score for HACs included in the AHRQ’s PSI 90 Composite. Domain 2 includes HACs within the CDC National Healthcare Safety Network (NHSN) Measures. Domain 1 is weighted at 25% and Domain 2 at 75%. After weighting is applied, the sum of the two domains make up a hospital’s overall HAC score. Hospitals with scores in the bottom 25% (worst performing quartile) receive a 1% payment reduction. HAC measures for each domain are listed below.
Hospitals and other groups, such as the American Medical Association, have sharply criticized the CMS HAC Program. According to a 2015 JAMA article, studies show that “penalization in the HAC program may not reflect poor quality of care, but rather measurement validity issues in component measures.” “Among participating hospitals, those that were penalized more frequently had quality accreditations, offered advanced services, were major teaching institutions, and had better performance on other process and outcome measures.” Examples of these factors are:
Despite these concerns, CMS has indicated little or no change for the HAC Program in terms of how hospitals will be scored or penalized. Organizations must aggressively implement measures to improve performance if they hope to avoid future penalties.
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Here are the top 10 strategies an organization can use to maximize performance on the prevention of hospital-acquired conditions.
See how you score on these HAC quiz questions.
B. Pressure Ulcers
C. Postoperative Venous Thromboembolism
D. Surgical Site Infection
B. Surgical-site infections
D. MRSA Bacteremia
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D. Surgical Site Infection at $21,000 per case.
Pressure Ulcers = $17,000
Postoperative VTE = $8,000
Falls = $7,234
A. Central Line-Associated Bloodstream Infections (CLABSI)×