Half of hospitals penalized for hospital-acquired conditions are repeat offenders

(Story updated at 3:25 p.m. ET.)

More than half of the hospitals that Medicare will penalize in 2016 for having the worst performance on measures of preventing patient harm are on that list for the second year in a row.

The CMS on Thursday released data that identified 758 hospitals that will see their Medicare payments reduced by 1% for ranking in the bottom quartile nationally under an Affordable Care Act program now in its second year. The CMS reported that 54% of the hospitals that ranked poorly in the second year also ranked poorly in the first. During the first year of the program, 724 hospitals were penalized.

“Our goal is for all hospitals to improve,” and roughly half did improve enough to escape the bottom quartile, said Dr. Patrick Conway, the CMS' deputy administrator and chief medical officer. Federal data on quality measures released earlier this month by the Agency for Healthcare Research and Quality also showed that between 2010 and 2013, progress was made in reducing patient harm and preventing avoidable deaths, he said.

He also noted that the law requires one-quarter of hospitals to be penalized each year.

The program—one of several created under the ACA to move the federal government toward paying for high performance, rather than volume of services—ranked performance for 3,308 hospitals on measures of bloodstream infections in patients with central lines; urinary-tract infections for catheterized patients; surgical-site infections; and a composite score of eight quality measures, such as pressure ulcers and sepsis.

The pay cuts took effect at the start of the federal fiscal year Oct. 1. Medicare is expected to reduce hospital spending by $364 million as a result.

Medicare has expanded its use of financial incentives for performance on quality, and has increased its public reporting of those quality measures for individual hospitals, medical groups, accountable care organizations and physicians.

The CMS on Thursday also updated and released new performance data for hospitals and physicians. The public disclosure has been praised, but quality experts have criticized the measures as flawed.

The Hospital-Acquired Condition (HAC) Reduction Program has drawn sharp criticism from hospitals and some experts, who say it will disproportionately affect hospitals that serve poorer and sicker patient populations.

Until the HAC program does more to reflect the demands of those poorer and sicker patients, the large hospitals and academic institutions that serve a majority of them will likely be penalized, and that may have contributed to the 50% of hospitals with penalties in both years, said Dr. Ashish Jha, a Harvard University health policy professor. Jha analyzed the first-year data for Kaiser Health News and found 54% of teaching hospitals were penalized.

Conway said the CMS continues to examine data adjustment for ways to improve.

Nationally, average performance improved for two of three measures in the HAC program's second year. The average score for the composite index, and central-line-associated bloodstream infections showed gains. That was not the case for catheter-associated urinary-tract infections, for which average performance declined. Surgical-site infections were new to the program this year.

Those shifts did not surprise Jha. “I think those are all completely predictable,” he said. Trends captured in the program reflect data elsewhere that show improvements in central-line infections, but no recent improvement for urinary-tract infections, which have not received the same time and attention.

Jha questioned the progress on the composite index, which he said might have been the result of changes to hospital recordkeeping, rather than changes that improved quality. “There is little reason to believe that care has gotten better,” he said.