CMS penalizes 758 hospitals under HAC program
- CMS has posted its new list of hospitals subject to payment adjustments under the Hospital-Acquired Condition (HAC) Reduction Program for fiscal year 2016.
- The program requires HHS to reduce payments to the worst-performing quartile of hospitals in terms of risk-adjusted HAC quality measures to 99% of what they would have been for their Medicare discharges.
- Across the FY 2015 and FY 2016 programs, hospitals' average performance improved on two of three measures that were included in both program years, CMS reports.
CMS reports for FY 2016, 758 of the 3,308 hospitals subject to the HAC Reduction Program are subject to payment reductions, while in FY 2015, 724 hospitals were subject to reductions.
The increase in hospitals in the worst-performing quartile is due in part to a change in the cutoff score, CMS reports. For FY 2016, the 75th percentile score cutoff was 6.75, compared to 7.00 in FY 2015.
"The cutoff contributed to the slight increase in the percentage of hospitals in the worst performing quartile, from 21.9 percent of applicable hospitals in FY 2015 to 22.9 percent of applicable hospitals in the FY 2016," CMS says. It adds of the 758 hospitals that landed in the worst-performing quartile in FY 2016, about 53.7% of those also landed there in FY 2015.
For the four measures, CMS reports:
- The mean Patient Safety Indicator (PSI) 90 Composite Index Value decreased from 0.89 to 0.86 in FY 2016;
- The mean Central Line-Associated Blood Stream Infection (CLABSI) Standardized Infection Ratio (SIR) decreased from 0.53 in FY 2015 to 0.48 in FY 2016;
- The mean Catheter-Associated Urinary Tract Infection (CAUTI) SIR increased slightly from 1.13 in FY 2015 to 1.17 in FY 2016; and
- The mean Surgical Site Infection (SSI) SIR in FY 2016 (the first year this measure was used in the program) was 0.95.
CMS estimates the payment reductions will generate savings of $364 million.