• Roshun Sankaran, Baris Gulseren, Ushapoorna Nuliyalu, Justin B Dimick, Kyle Sheetz, Emily Arntson, Karan Chhabra, and Andrew M Ryan.
• Jt Comm J Qual Patient Saf. 2020 Aug 1; 46 (8): 438-447.

BackgroundThe Hospital-Acquired Condition Reduction Program (HACRP) from the Centers for Medicare & Medicaid Services (CMS) reduces Medicare payments to hospitals with high rates of hospital-acquired conditions (HACs) by 1% each year. It is not known how the savings accruing to CMS from such penalties compare to savings resulting from a reduction in HACs driven by this program. This study compares the reported savings to CMS from financial penalties levied under the HACRP with savings resulting from potential reductions in HACs.MethodsUsing a random sample of 20% of Medicare claims data (January 1, 2009-September 30, 2014), the research team evaluated the association between HACs and 90-day episode spending (adjusted to 2015 dollars), then estimated potential annual savings to CMS if there was a relative decrease in incidence of all HACs by 1%-20%. These savings were then compared to the actual collected HACRP penalties reported by CMS in 2015.ResultsAll HACs were associated with significant increases in total 90-day episode spending, ranging from $3,183 for iatrogenic pneumothorax to $21,654 for postoperative hip fracture. The total estimated savings to Medicare from potential reduction in all HACs ranged from $2.2 million to $44 million per year, an amount much lower than the $361 million in penalties levied on hospitals per year for HACs.ConclusionThe penalties levied under the HACRP far exceed the potential cost savings accruing from a 1%-20% reduction in HACs that might result from hospitals' efforts in response to the program.Copyright © 2020. Published by Elsevier Inc.

9 keywords...

hide…