
The penalties are tied to the latest results from the Centers for Medicare & Medicaid Services' (CMS) Hospital-Acquired Condition (HAC) Reduction Program, a Medicare pay-for-performance program that links Medicare payments to healthcare quality in the inpatient hospital setting.
Included in the Affordable Care Act (ACA), the HAC Reduction Program requires the Secretary of Health and Human Services to adjust payments to hospitals that rank in the worst-performing 25% of all qualifying hospitals (more than 3,300) with respect to HAC quality measures. The payment reduction occurs when CMS pays hospital claims.
For fiscal year 2018, these measures include the following:
- Central line-associated bloodstream infection (CLABSI)
- Catheter-associated urinary tract infection (CAUTI)
- Surgical site infection (SSI) for colon surgeries and hysterectomy
- Methicillin-resistant Staphylococcus aureus (MRSA) bacteremia
- Clostridium difficile infection (CDI)
- Pressure ulcers
- Hip fractures (due to in-hospital fall)
- Postoperative sepsis
- Postoperative respiratory failure
- Postoperative wound ruptures
- Perioperative pulmonary embolism or deep vein thrombosis
Types of hospitals evaluated include the following:
- Critical access hospitals
- Rehabilitation hospitals and units
- Long-term care hospitals
- Psychiatric hospitals and units
- Children's hospitals
A Modern Healthcare report noted that the American Hospital Association (AHA) has argued that the program's methodology fails to recognize improvement, quoting Nancy Foster, vice president for quality and patient safety policy at AHA, as saying, "The Congressional mandate that a quarter of hospitals should be penalized every year creates this odd situation in which more than half of the hospitals being penalized have the same or relatively the same performance as many of the hospitals who escaped penalty."