Reducing Hospital-Acquired Conditions

One thing that shouldn’t happen to patients is that using health services or products actually gives them a new health problem or exacerbates an existing one.  So a variety of initiatives, including one by our friends at CMS, have been presented to reduce health care associated or hospital-acquired conditions.  Research published in the Journal of the American Medical Society examines how well the CMS hospital effort seems to be working.   (JAMA Article)   CMS’ program is based 35% on a hospital’s score on AHRQ patient safety indicators and 65% on performance on measures of central line associated blood infections and catheter associated urinary tract infections.  A hospital can have its payments reduced by 1% for not doing well on these measures.  And in the most recent measurement period, hospitals lost $373 million in Medicare reimbursement in penalties.  Analysis of characteristics of hospitals being penalized suggests that there are measurement issues such as data evaluation and coding, and sociodemographic adjustment issues.  The researchers looked at all hospitals subject to the program and compared various characteristics with their scores on the measures.  The characteristics analyzed included resources, services offered, accreditation measures and performance on other quality measures.  3284 hospitals were in the program and 721 or 22% were penalized.  Hospitals were more likely to be penalized if they were larger, had more hospital admissions, were accredited, were a level 1 trauma center, had a higher nurse-to-bed ratio or were clinical surgery registry participants.  Larger teaching hospitals were much more like to pay a penalty, as were safety-net facilities and those serving a more difficult case mix.  Just looking at a number of factors indicates that it is counter-intuitive that these facilities would have worse performance.  And the most paradoxical finding of all is that hospitals that perform best on other process of care quality measures are the most likely to be penalized.  In fact, the hospitals with the highest overall quality score were 5 times more likely to be penalized than those facilities with the lowest ones.  It is very clear that, as with the hospital readmissions reduction program, the measures used are not adequate to the task of discerning which facilities are truly delivering worse care.  Meanwhile, good quality hospitals are wrongly losing millions of dollars in reimbursement.