Together with the CMS' value-based purchasing and readmissions reduction programs, both of which began in fiscal 2013, the three initiatives are part of a sweeping effort to move the agency toward paying for high-value care. While quality experts and hospital leaders laud the goals of the HAC reduction program, they have a lengthy list of concerns, including issues with the measures the CMS chose, the potential for multiple penalties under overlapping programs, and the prospect that teaching hospitals will be disproportionately affected. They question whether the programs will actually help hospitals achieve better quality care, and warn that the combined impact of penalties from three pay-for-performance programs could hurt some hospitals.
On the other hand, some consumer-oriented groups say the HAC program doesn't go far enough and leaves out important quality measures.
One teaching hospital that could be impacted by the HAC program is UCSF Medical Center, a 660-bed hospital in San Francisco. According to CMS data released in August and November, UCSF's 2015 base-operating DRG payments will be docked 0.21% under the agency's value-based purchasing program, and another 0.02% under the federal readmissions reduction program.
Dr. Joshua Adler, UCSF Medical Center's chief medical officer, said the hospital has worked hard to reduce patient harm and curb costs. But he said there was still a good chance that the medical center could fall into the penalty range for the next year's HAC reduction program, too. “We absolutely worry about getting dinged by all three,” Adler said.
When the CMS finalized details of the HAC reduction program in the final inpatient prospective payment system rule released in August, the agency estimated that 48.6% of the nation's teaching hospitals would be penalized for high rates of HACs.
Adler said teaching hospitals are being unfairly affected because they have robust surveillance infrastructure in place and are able to identify more adverse events than other types of hospitals identify. “We're just bigger and we're more historically oriented toward this kind of work,” he said. “We find things that others don't.”
Still, he said federal pay-for-performance initiatives have energized UCSF's quality-improvement program and bolstered efforts to target conditions measured in CMS programs, such as catheter-associated urinary tract infections.