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.