Medicare's Policy to Limit Payment for Hospital-Acquired Conditions: The Impact on Safety Net Providers

2011 ◽  
Vol 22 (2) ◽  
pp. 638-647 ◽  
Author(s):  
Megan McHugh ◽  
Timothy C. Martin ◽  
John Orwat ◽  
Kevin Van Dyke
Keyword(s):  
Safety Net ◽  
Hospital Acquired Conditions ◽  
Safety Net Providers ◽  
Hospital Acquired ◽  
The Impact

scholarly journals Impact of Medicare’s Hospital-Acquired Condition Policy on Infections in Safety Net and Non–Safety Net Hospitals

2015 ◽  
Vol 36 (6) ◽  
pp. 649-655 ◽  
Author(s):  
Louise Elaine Vaz ◽  
Kenneth P. Kleinman ◽  
Alison Tse Kawai ◽  
Robert Jin ◽  
William J. Kassler ◽  
...  
Keyword(s):  
Bloodstream Infection ◽  
Financial Incentives ◽  
Safety Net ◽  
The United States ◽  
Central Line ◽  
Unintended Consequences ◽  
Infection Rates ◽  
Healthcare Associated Infection ◽  
Hospital Acquired Conditions ◽  
Hospital Acquired

BACKGROUNDPolicymakers may wish to align healthcare payment and quality of care while minimizing unintended consequences, particularly for safety net hospitals.OBJECTIVETo determine whether the 2008 Centers for Medicare and Medicaid Services Hospital-Acquired Conditions policy had a differential impact on targeted healthcare-associated infection rates in safety net compared with non–safety net hospitals.DESIGNInterrupted time-series design.SETTING AND PARTICIPANTSNonfederal acute care hospitals that reported central line–associated bloodstream infection and ventilator-associated pneumonia rates to the Centers for Disease Control and Prevention’s National Health Safety Network from July 1, 2007, through December 31, 2013.RESULTSWe did not observe changes in the slope of targeted infection rates in the postpolicy period compared with the prepolicy period for either safety net (postpolicy vs prepolicy ratio, 0.96 [95% CI, 0.84–1.09]) or non–safety net (0.99 [0.90–1.10]) hospitals. Controlling for prepolicy secular trends, we did not detect differences in an immediate change at the time of the policy between safety net and non–safety net hospitals (P for 2-way interaction, .87).CONCLUSIONSThe Centers for Medicare and Medicaid Services Hospital-Acquired Conditions policy did not have an impact, either positive or negative, on already declining rates of central line–associated bloodstream infection in safety net or non–safety net hospitals. Continued evaluations of the broad impact of payment policies on safety net hospitals will remain important as the use of financial incentives and penalties continues to expand in the United States.Infect Control Hosp Epidemiol 2015;00(0): 1–7

scholarly journals Measurement matters: changing penalty calculations under the hospital acquired condition reduction program (HACRP) cost hospitals millions

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Olga A. Vsevolozhskaya ◽  
Karina C. Manz ◽  
Pierre M. Zephyr ◽  
Teresa M. Waters
Keyword(s):  
Improve Patient Safety ◽  
Hospital Performance ◽  
Highly Sensitive ◽  
Hospital Acquired Conditions ◽  
Reduction Program ◽  
Hospital Discharge Records ◽  
Hospital Acquired ◽  
The Impact ◽  
Over Time

Abstract Background Since October 2014, the Centers for Medicare and Medicaid Services has penalized 25% of U.S. hospitals with the highest rates of hospital-acquired conditions under the Hospital Acquired Conditions Reduction Program (HACRP). While early evaluations of the HACRP program reported cumulative reductions in hospital-acquired conditions, more recent studies have not found a clear association between receipt of the HACRP penalty and hospital quality of care. We posit that some of this disconnect may be driven by frequent scoring updates. The sensitivity of the HACRP penalties to updates in the program’s scoring methodology has not been independently evaluated. Methods We used hospital discharge records from 14 states to evaluate the association between changes in HACRP scoring methodology and corresponding shifts in penalty status. To isolate the impact of changes in scoring methods over time, we used FY2018 hospital performance data to calculate total HAC scores using FY2015 through FY2018 CMS scoring methodologies. Results Comparing hospital penalty status based on various HACRP scoring methodologies over time, we found a significant overlap between penalized hospitals when using FY 2015 and 2016 scoring methodologies (95%) and between FY 2017 and 2018 methodologies (46%), but substantial differences across early vs later years. Only 15% of hospitals were eligible for penalties across all four years. We also found significant changes in a hospital’s (relative) ranking across the various years, indicating that shifts in penalty status were not driven by small changes in HAC scores clustered around the penalty threshold. Conclusions HACRP penalties have been highly sensitive to program updates, which are generally announced after performance periods are concluded. This disconnect between performance and penalties calls into question the ability of the HACRP to improve patient safety as intended.

scholarly journals Excluding Orphan Drugs from the 340B Drug Discount Program: the Impact on 18 Critical Access Hospitals

2012 ◽  
Vol 3 (1) ◽  
Author(s):  
Madeline Carpinelli Wallack ◽  
Todd Sorensen
Keyword(s):  
Federal Government ◽  
Orphan Drug ◽  
Orphan Drugs ◽  
Safety Net ◽  
Original Research ◽  
Critical Access Hospitals ◽  
Patient Protection ◽  
High Prevalence ◽  
Safety Net Providers ◽  
The Impact

Purpose: The 340B Drug Pricing Program is a federal program designed to reduce the amount that safety net providers spend on outpatient drugs. The Patient Protection and Affordable Health Care Act of 2010 extended eligibility for 340B to critical access hospitals (CAHs) for all drugs except those designated as "orphan." Because this policy is unprecedented, this study quantifies the gross financial impact that this exemption has on a group of CAHs. Methods: Drug spending for 2010 from 18 CAHs in Minnesota and Wisconsin are reviewed to identify the prevalence of orphan drug purchases and to calculate the price differentials between the 340B price and the hospitals' current cost. Results: The 18 CAHs' purchases of orphan drugs comprise an average of 44% of the total annual drug budgets, but only 5% of units purchased, thus representing a very high proportion of their expenditures. In the aggregate, the 18 hospitals would have saved $3.1 million ($171,000 average per hospital) had purchases of drugs with orphan designations been made at the 340B price. Because CAH claims for Medicare are reimbursed on a cost-basis, the Federal government is losing an opportunity for savings. Conclusion: The high prevalence of orphan drug use and considerable potential for cost reduction through the 340B program demonstrate the loss of benefit to the hospitals, Federal government and the states.   Type: Original Research

scholarly journals Measurement Matters: Changing Penalty Calculations under the Hospital Acquired Condition Reduction Program (HACRP) Cost Hospitals Millions

2020 ◽  
Author(s):  
Olga A. Vsevolozhskaya ◽  
Karina C. Manz ◽  
Pierre M. Zephyr ◽  
Teresa M. Waters
Keyword(s):  
Improve Patient Safety ◽  
Hospital Performance ◽  
Highly Sensitive ◽  
Hospital Acquired Conditions ◽  
Reduction Program ◽  
Hospital Discharge Records ◽  
Hospital Acquired ◽  
The Impact ◽  
Over Time

AbstractBackgroundSince October 2014, the Centers for Medicare and Medicaid Services has penalized 25% of U.S. hospitals with the highest rates of hospital-acquired conditions under the Hospital Acquired Conditions Reduction Program (HACRP). While early evaluations of the HACRP program reported cumulative reductions in hospital-acquired conditions, more recent studies have not found a clear association between receipt of the HACRP penalty and hospital quality of care. We posit that some of this disconnect may be driven by frequent scoring updates. The sensitivity of the HACRP penalties to updates in the program’s scoring methodology has not been independently evaluated.MethodsWe used hospital discharge records from 14 states to evaluate the association between changes in HACRP scoring methodology and corresponding shifts in penalty status. To isolate the impact of changes in scoring methods over time, we used FY2018 hospital performance data to calculate total HAC scores using FY2015 through FY2018 CMS scoring methodologies.ResultsComparing hospital penalty status based on various HACRP scoring methodologies over time, we found a significant overlap between penalized hospitals when using FY 2015 and 2016 scoring methodologies (95%) and between FY 2017 and 2018 methodologies (46%), but substantial differences across early vs later years. Only 15% of hospitals were eligible for penalties across all four years. We also found significant changes in a hospital’s (relative) ranking across the various years, indicating that shifts in penalty status were not driven by small changes in HAC scores clustered around the penalty threshold.ConclusionsHACRP penalties have been highly sensitive to program updates, which are generally announced after performance periods are concluded. This disconnect between performance and penalties calls into question the ability of the HACRP to improve patient safety as intended.

scholarly journals The Impact of Hospital-Acquired Conditions on Medicare Program Payments

2014 ◽  
Vol 4 (4) ◽  
pp. E1-E23 ◽  
Author(s):  
Amy Kandilov ◽  
Nicole Coomer ◽  
Kathleen Dalton
Keyword(s):  
Medicare Program ◽  
Hospital Acquired Conditions ◽  
Hospital Acquired ◽  
The Impact

Medicare’s Policy Not To Pay For Treating Hospital-Acquired Conditions: The Impact

2009 ◽  
Vol 28 (5) ◽  
pp. 1485-1493 ◽  
Author(s):  
Peter D. McNair ◽  
Harold S. Luft ◽  
Andrew B. Bindman
Keyword(s):  
Hospital Acquired Conditions ◽  
Hospital Acquired ◽  
The Impact

Assessment of the impact of comorbidities on perioperative complications in pediatric neurosurgery

2014 ◽  
Vol 13 (5) ◽  
pp. 579-582 ◽  
Author(s):  
Akash J. Patel ◽  
Ahilan Sivaganesan ◽  
Robert J. Bollo ◽  
Alison Brayton ◽  
Thomas G. Luerssen ◽  
...  
Keyword(s):  
Perioperative Complications ◽  
Cumulative Effect ◽  
Pediatric Neurosurgery ◽  
Related Factors ◽  
Retrospective Assessment ◽  
Increased Risk ◽  
Hospital Acquired Conditions ◽  
Perioperative Complication ◽  
Hospital Acquired ◽  
The Impact

Object Recent attempts to control health care costs focus on reducing or eliminating payments for complications, hospital-acquired conditions, and provider preventable conditions, with payment restrictions applied uniformly. A patient's preexisting comorbidities likely influence the perioperative complication incidence. This relationship has not previously been examined in pediatric neurosurgery. Methods The authors conducted a retrospective assessment of prospectively collected relevant patient comorbidities and morbidity and mortality events at a large pediatric neurosurgical unit over a 5-year period. The authors examined the impact of specific comorbidities and the cumulative effect of multiple comorbidities on complication incidence. Results A total of 1990 patients underwent 3195 procedures at the authors' institution during the 5-year study period. Overall, 396 complications were analyzed; 298 patients (15.0%) experienced at least one complication. One or more comorbidities were present in 45.9% of patients. Renal comorbidities were clearly associated with the increased incidence of complications (p = 0.02), and they were specifically associated with infection (p = 0.006). Neurological comorbidities had a borderline association with complications (p = 0.05), and they were specifically associated with death (p = 0.037). A patient's having more comorbidities did not correlate with an increased risk of a perioperative complication (p = 0.8275). Conclusions The complication incidence in pediatric neurosurgery is variable and may be influenced by the type of neurosurgical procedure and patient-related factors. While patient-related factors beyond the control of the provider can significantly impact complications and hospital-acquired conditions in pediatric neurosurgery, an increasing number of comorbidities do not correlate with an increased risk of complications per patient.

scholarly journals Hospital-acquired conditions and length of stay in the pregnancy and puerperal cycle

2019 ◽  
Vol 53 ◽  
pp. 64
Author(s):  
Thales Philipe Rodrigues da Silva ◽  
Ariene Silva do Carmo ◽  
Taiane Gonçalves Novaes ◽  
Larissa Loures Mendes ◽  
Alexandra Dias Moreira ◽  
...  
Keyword(s):  
Health Care ◽  
Length Of Stay ◽  
Cesarean Section ◽  
Health Care Providers ◽  
Care Providers ◽  
Cohen’S D ◽  
Hospital Acquired Conditions ◽  
Cohen's D ◽  
Hospital Acquired ◽  
The Impact

OBJECTIVE: To analyze the impact of the Hospital-Acquired Conditions (HAC) in women in the puerperal and pregnancy cycle during length of stay. METHODS: This cross-sectional study was conducted with 113,456 women, between July 2012 and July 2017, in Brazil’s national hospitals of the supplementary healthcare networks and philanthropists accredited to the Unified Health System (SUS). Data on hospital discharges were collected using the Diagnosis-Related Groups (DRG Brasil) system. All DRGs of the major diagnostic category 14 (MDC14), including pregnancy, childbirth and puerperium, were included. The impact of HAC on length of stay was estimated by Student’s t-test, and the effect size by Cohen’s d, which allows to assess clinical relevance. RESULTS: The most prevalent diagnostic categories related to MDC14 were vaginal and cesarean deliveries without complicating diagnoses, both at institutions accredited to SUS and those for supplementary health care. The prevalence of HAC was 3.8% in supplementary health and 2.5% in SUS. Hospitals providing services to supplementary health care providers had a longer length of stay considering HAC for patients classified as DRG: cesarean section with complications or comorbidities at admission (p < 0.001; Cohen’s d = 0.74), cesarean section without complications or comorbidities at admission (p < 0.001, Cohen’s d = 0.31), postpartum and post abortion without listed procedure (p < 0.001, Cohen’s d = 1.05), and other antepartum diagnoses with medical complications (p < 0.001; Cohen’s d = 0.77). CONCLUSIONS: This study showed that the prevalence of HAC was low both in the institutions accredited to attend by SUS and in those of supplementary health; however, its presence contributes to increasing the length of stay in cases of cesarean sections without complications or comorbidities in supplementary health institutions.

scholarly journals Impact of Extent of Resection on Incidence of Postoperative Complications in Patients With Glioblastoma

Neurosurgery ◽  
2019 ◽  
Vol 86 (5) ◽  
pp. 625-630 ◽  
Author(s):  
Dimitri Laurent ◽  
Rachel Freedman ◽  
Logan Cope ◽  
Patricia Sacks ◽  
Joe Abbatematteo ◽  
...  
Keyword(s):  
Extent Of Resection ◽  
Magnetic Resonance Images ◽  
Gross Total Resection ◽  
Subtotal Resection ◽  
Total Resection ◽  
Resection Group ◽  
Patient Safety Indicators ◽  
Hospital Acquired Conditions ◽  
Hospital Acquired ◽  
The Impact

Abstract BACKGROUND Extent of resection (EOR) is well established as correlating with overall survival in patients with glioblastoma (GBM). The impact of EOR on reported quality metrics such as patient safety indicators (PSIs) and hospital-acquired conditions (HACs) is unknown. OBJECTIVE To perform a retrospective study to evaluate possible associations between EOR and the incidence of PSIs and HACs. METHODS We queried all patients diagnosed with GBM who underwent surgical resection at our institution between January 2011 and May 2017. Pre- and postoperative magnetic resonance images were analyzed for EOR. Each chart was reviewed to determine the incidence of PSIs and HACs. RESULTS A total of 284 patients met the inclusion criteria. EOR ranged from 39.00 to 100%, with a median of 99.84% and a mean of 95.7%. There were 16 PSI, and 13 HAC, events. There were no significant differences in the rates of PSIs or HACs when compared between patients stratified by gross total resection (EOR ≥ 95%) and subtotal resection (EOR &lt; 95%). The odds of encountering a PSI or HAC were 2.5 times more likely in the subtotal resection group compared to the gross total resection group (P = .58). After adjusting for confounders, the odds of encountering a PSI or HAC in the subtotal resection group were 3.9 times greater than for the gross total resection group (P &lt; .05). CONCLUSION Gross total resection of GBM is associated with a decreased incidence of PSIs and HACs, as compared to subtotal resection.

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