Reducing Hospital-Acquired Conditions Reducing hospital-acquired conditions (HACs) is the goal of the Partnership for Patients, as imposed by HAC, But in 2008, the IPPS final rule promotes quality care by enacting a 1 percent reimbursement cut for hospitals with the poorest performance (in the lowest quartile) in reducing hospital-acquired
Full Answer
What is the hospital-acquired condition reduction program for Medicare?
The Hospital-Acquired Condition (HAC) Reduction Program is a value-based-purchasing program for Medicare that supports the Centers for Medicare and Medicaid Services’ (CMS’) long-standing effort to link Medicare payments to healthcare quality in the inpatient hospital setting.
How does CMS evaluate hospital performance for Medicare payments?
Under the program, CMS reduces overall Medicare payments for hospitals that rank in the worst-performing quartile of all hospitals on measures of hospital-acquired conditions. On an annual basis, CMS evaluates overall hospital performance by calculating Total HAC Scores as the equally weighted average of scores on measures included in the program.
What is the hospital acquired condition (HAC) reduction program?
Hospital-Acquired Condition (HAC) Reduction Program What is the Hospital-Acquired Condition (HAC) Reduction Program? The HAC Reduction Program encourages hospitals to improve patients’ safety and reduce the number of conditions people experience from their time in a hospital, such as pressure sores and hip fractures after surgery.
Do financial incentives for hospitals reduce hospital-acquired infections?
The purpose of this study was to simulate incentives for reducing hospital-acquired infections under various payment configurations by M … OBJECTIVEThe financial incentives for hospitals to improve care may be weaker if higher insurer payments for adverse conditions offset a portion of hospital costs.
Why is Medicare reimbursement reduced for hospital acquired conditions?
Why is the HAC Reduction Program important? The HAC Reduction Program encourages hospitals to improve patients' safety and implement best practices to reduce their rates of infections associated with health care.
Are hospital acquired conditions reimbursed by Medicare?
The Hospital-Acquired Condition (HAC) Reduction Program is a value-based-purchasing program for Medicare that supports the Centers for Medicare and Medicaid Services' (CMS') long-standing effort to link Medicare payments to healthcare quality in the inpatient hospital setting.
How are hospitals penalized for hospital acquired infections?
THE CENTERS FOR MEDICARE AND MEDICAID SERVICES (CMS) has announced that it will penalize 800 hospitals for their hospital-acquired condition (HAC) rates by withholding 1% of their total Medicare payments for patients discharged this fiscal year.
What does Medicare consider to be a hospital acquired condition?
The condition must be associated with a high cost of treatment or high occurrence rates within hospital settings. The condition results in higher payment to the facility when submitted as a secondary diagnosis. The condition can reasonably be prevented by adoption and implementation of evidence-based guidelines.
Which hospital acquired conditions are not reimbursed by Medicare?
The conditions that will no longer be covered by Medicare include mediastinitis after coronary artery bypass graft (CABG) surgery, bed sores, air embolism, falls, leaving objects inside the patient during sugery, vascular catheter-associated infections and certain catheter-associated urinary tract infections.
Are hospitals penalized for hospital acquired conditions?
Since its implementation in 2014, the HAC program has penalized 1,978 hospitals at least once as of 2021. Just over 1,300 of those hospitals have been penalized at least twice, while 77 hospitals have received Medicare payment cuts every year.
What percentage of HAC reduction program is calculated from Hai?
The HAC Reduction Program imposes a 1 percent reduction to Medicare inpatient payments for hospitals in the worst performing quartile (25 percent) of risk-adjusted national HAC rates.
Are hospitals responsible for hospital acquired infections?
Hospitals and medical facilities may be held liable for a patient's infection when a causal link can be established between their policies or staff members' actions and the patient's condition.
What is included in HAC score calculation?
With the Equal Measure Weights approach, CMS calculates each hospital's Total HAC Score as the equally weighted average of the hospital's measure scores. CMS calculates each hospital's Total HAC Score as the sum of the contributions of Winsorized z-scores to Total HAC score for each measure.
What hospital acquired conditions are HACs?
A Hospital Acquired Condition (HAC) is a medical condition or complication that a patient develops during a hospital stay, which was not present at admission. In most cases, hospitals can prevent HACs when they give care that research shows gets the best results for most patients.
How can hospital acquired infection be reduced?
10 Steps to Preventing Spread of Infection in HospitalsWash Your Hands. ... Create an Infection-Control Policy. ... Identify Contagions ASAP. ... Provide Infection Control Education. ... Use Gloves. ... Provide Isolation-Appropriate Personal Protective Equipment. ... Disinfect and Keep Surfaces Clean. ... Prevent Patients From Walking Barefoot.More items...•
What are examples of hospital acquired conditions?
Hospital-Acquired ConditionsForeign Object Retained After Surgery.Air Embolism.Blood Incompatibility.Stage III and IV Pressure Ulcers.Falls and Trauma. Fractures. ... Manifestations of Poor Glycemic Control. Diabetic Ketoacidosis. ... Catheter-Associated Urinary Tract Infection (UTI)Vascular Catheter-Associated Infection.More items...•
What's The Issue?
- As part of its efforts to become a more prudent purchaser of health care services, Medicare has worked to create incentives for hospitals to avoid making patients sicker, instead of healthier, during their inpatient stay. These so-called hospital-acquired conditions (HACs) can lead to poor patient outcomes and higher spending on health care. The latest effort is the implementation of …
What's The background?
- When a patient goes to the hospital to receive care for one condition and develops another condition during that hospital stay, the second condition is referred to as "hospital-acquired." Examples of HACs include pressure ulcers, adverse drug events, infections at the site of surgery or associated with use of a catheter, and falls during the hospital stay. The Partnership for Patie…
What's The Law?
- The Affordable Care Act established a new program to encourage hospitals to reduce the occurrence of HACs. Effective October 1, 2014, the HAC Reduction Programreduces Medicare payments to the poorest-performing hospitals by 1 percent. The poorest performing are those hospitals that have HAC scores in the top 25 percent nationally. The penalty appli...
What's The Debate?
- Hospital associations have significant concerns with how Congress designed the program and how CMS is implementing it. We discuss these concerns below. Program Design The statute requires the lowest-performing hospitals to be subject to the penalty regardless of whether the hospital's performance is improving or whether the performance of poorest-performing hospital…
What's Next?
- CMS expects to provide hospitals with information about the calculation of their HAC score for the fiscal year 2016 adjustment in late summer 2015. Under the law, up to 25 percent of hospitals will be subject to the HAC penalty, but which hospitals are affected may change over time for multiple reasons. In future years, CMS is increasing the number of NHSN measures and using m…
Resources
- American Hospital Association, Call for Public Comment, Reevaluation of Hospital-Acquired Condition Reduction Program Scoring Methodology by the Yale Center for Outcomes Research and Evaluation (Washington, DC: AHA, December 18, 2014). Centers for Medicare and Medicaid Services, Fiscal Year 2015 Results for the CMS Hospital-Acquired Condition Reduction Program …
About Health Policy Briefs
- Written by Amanda Cassidy Health Policy Consultant Editorial review by Suzanne Delbanco Executive Director Catalyst for Payment Reform Ashish Jha K. T. Li Professor of International Health and Health Policy Harvard T.H. Chan School of Public Health Director, Harvard Global Health Institute Rob Lott Deputy Editor Health Affairs Tracy Gnadinger Assistant Editor Health Af…