Ideas written into law in 2010 to push hospitals toward better and safer care are now a pervasive part of doing business with Medicare.
Next year, for the first time, the CMS will impose a 1% penalty on hospitals that fall within the worst-performing quartile on measures of bad things that happen to patients during their stays, such as pressure ulcers, pulmonary embolisms and infections.
Last week, the agency identified 724 hospitals that will get hit with the first round of penalties imposed under the Hospital-Acquired Condition Reduction Program. They include institutions such as Northwestern Memorial Hospital in Chicago and the Cleveland Clinic. The CMS estimated that overall Medicare payments would drop by roughly $330 million in 2015 due to the HAC program.
It's part of the healthcare reform law's wide-ranging effort, along with the readmissions reduction and value-based purchasing programs, to make Medicare payments reflect the quality of care delivered. In fiscal 2015 the programs together put 5.5% of inpatient Medicare payments at risk.
“There's a tendency to think it's a bonus here or penalty there, but these are pretty significant when you add them all together,” said Eric Fontana, practice manager for research and insights at the Advisory Board Co.
The CMS also just posted the third iteration of data for Medicare's value-based purchasing program.
In the latest round, the number of hospitals getting a bonus exceeds the number being penalized by about 340, a reversal from last year. Still, more than 1,300 are in negative territory.