Health Affairs is weighing in on the issue of the CMS program to reduce HACs through financial penalties of 1% this fiscal year. In an issue brief published August 6 on its website (http://bit.ly/1HtcBh0), author and Health Policy Consultant, Amanda Cassidy, outlines the background and some of the current debate about the program.
Among the items she cites as persistent problems are the overlap of measures. For example, she mentions that central line-associated bloodstream infections (CLABSI) are part of the healthcare-acquired conditions reduction program, but also part of Value-based Purchasing, which many feel is a double penalty.1
Another point of contention is that the law requires that hospitals be graded on a curve. That means that if everyone scores between the 90th and 100th percentile, those in the bottom will be penalized, even though they are, by definition, doing very well.
Others argue that using a composite measure, the claims-based PSI-90, isn’t in keeping with the idea that all HACs be preventable. A composite isn’t preventable. Only a specific condition is. The composite currently makes up the entirety of the first domain used in the HAC education program. That kind of measure also doesn’t reflect patient complexity, critics say, and can include surveillance bias such that hospitals which are most vigilant about looking for problems end up finding more and are thus penalized more, and that those with larger volumes may pay more penalties than worse hospitals with small volumes that get to use national averages in their scores.
CMS says keeping the claims-based composite measure is important because the data come from “a widely available data source that produces minimal administrative and financial burden on hospitals.” CMS has, though, reduced the weight assigned to PSI-90 from the original 50% and increased the number and weight of other measures.
Next up, the author says, 25% of hospitals will find out they will receive a penalty at the end of the summer/beginning of fall. However, in the future, CMS plans on increasing the number of measures a hospital can report and the number of measures from the National Health and Safety Network that were the counterweight to the PSI-90 composite in the second domain of the program metrics. Hospitals can also expand measures to other locations, like the intensive care unit or emergency department. These changes, the author says, mean a hospital that is penalized this year may find it easier to avoid penalty in the future.1
The PSI-90 composite itself may be in for a change, as the National Quality Forum is currently reviewing the components and weight, she says. Lastly, CMS is changing the way it will calculate the HAC total for 2017 that will give a maximum 10 as a value for hospitals for each NHSN measure that a hospital doesn’t report.1
- Health Policy Brief: Medicare’s Hospital-Acquired Condition Reduction Program. Health Affairs, August 6, 2015.