Half of Hospitals Penalized for Hospital-Acquired Conditions Are Repeat Offenders

Everyone wants to see hospital performance and patient safety improve, but not everyone agrees how to achieve this goal.

Critics of Medicare’s Hospital Acquired Condition (HAC) reduction program have been outspoken on the topic of penalizing hospitals that perform poorly when it comes to rates of hospital acquired conditions like blood stream infections, catheter associated urinary tract infections and surgical site infections. Learn more about this issue and how half of the hospitals penalized are repeat offenders.

Half of Hospitals Penalized for Hospital-Acquired Conditions Are Repeat Offenders

Dr. Ashish Jha, a Harvard University health policy professor told Modern Healthcare that there is “little reason to believe care has gotten better,” despite the new program which by law requires a quarter of the nation’s hospitals to be penalized each year, reducing Medicare’s spending by $36.4 million.

Now in it’s second year, more than half of the hospitals penalized by Medicare in 2016 are on the list for a second year in a row for having the worst performance on measures of preventing patient harm.

In fact, the list is growing — in its first year, 724 hospitals were penalized compared to the 758 hospitals that saw their Medicare payments reduced by 1% for ranking in the bottom quartile under the Affordable Care Act Program this year, Modern Healthcare reports.

“The program has drawn sharp criticism from hospitals and some experts, who say it will disproportionately affect hospitals that serve poorer and sicker patient populations,” Modern Healthcare’s Melanie Evans reports, adding that “Jha analyzed the first-year data for Kaiser Health News and found 54% of teaching hospitals were penalized.”

There’s no question that hospitals across the country need to reduce their rates of hospital acquired conditions, but why isn’t the program’s reward/punitive-based approach working? Ultimately, “rewards and consequences don’t work,” writes Dominque Smith, the author of “Better Than Carrots or Sticks.“They may result in short-term changes, but in reality they promote compliance and little else.”

Although the debate surrounding the use of rewards and punishment is one rooted in educational models, it applies directly to Medicare’s Hospital Acquired Condition (HAC) reduction program, which seeks to encourage improved performance in hospitals across the United States.

“Our goal is for all hospitals to improve,’ and roughly half did improve enough to escape the bottom quartile,” Dr. Patrick Conway, the CMS’ deputy administrator and chief medical officer told Evans.

One could argue, however, that the problem is not one of motivation. It’s not that low performing hospitals don’t care about patient safety or performance. Instead, these hospitals are struggling to find ways to improve, unsure of how to overcome the barriers that stand in their way. Increasing those barriers by reducing their funding is unlikely to help them find methods to make long-term improvements.

“Facilities across the U.S. are actively trying to meet the diverse needs of their patient populations,” Jean Chenoweth, Truven’s senior vice president of performance improvement told Modern Healthcare’s Sabriya Rice. “Top performers have the right processes in place and a commitment to improvement, so they tend to find those solutions.”

Looking at the top performing hospitals in the U.S. showed that success hinged on:

A culture of transparency
An organizational culture that is interactive, open, collaborative and accountable
Celebrating successes
Clear goals and a strategic vision
Strong communication and collaboration across all levels of the organization

Perhaps helping low performing hospitals model these same organizational processes and behaviors rather than punishing them for poor patient outcomes will produce better results and experiences for patients.

How can hospitals penalized for hospital-acquired conditions improve patient outcomes? Share your thoughts with us in the comments below.

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