Hospital-acquired infection measures flawed, study authors say, as top-tier hospitals see most fines

Accredited hospitals that offer advanced services, are major teaching institutions and have better performance and outcome measures are penalized more frequently than other providers for hospital-acquired conditions, according to a new study in the Journal of the American Medical Association that claims to have exposed a major flaw with program.

Accredited hospitals that offer advanced services, are major teaching institutions and have better performance and outcome measures are penalized more frequently than other providers for hospital-acquired conditions, according to a new study in the Journal of the American Medical Association that claims to have exposed a major flaw with program.

The study found the Centers for Medicare and Medicaid reduces payments to these hospitals more often than others taking part in a Hospital-Acquired Condition Reduction Program.

The flaw is costing hospitals millions of dollars, according to one of the study's authors, Dr. Karl Bilimoria, director of the Surgical Outcomes and Improvement Center at Northwestern University, who said some of the metrics used by HAC don't really reflect quality.

The hospitals flagged serve more complex cases.

[Also: See which hospitals failed and were fined for hospital-acquired conditions (map, list)]

"Paradoxically, they have a worse performance rating because they're finding more events," he said.

JAMA went into the study knowing a number of large hospitals had voiced concerns about how much they were being penalized, he said. "What we found led us to believe they were doing pretty well overall," Bilimoria said. "Measures in the HAC program were not measuring quality care."

The authors plan to meet with CMS officials at a date yet set, he said. They would like to see the quality measures changed this year.

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"The program is well intentioned; they were picking measures that seemed right, on the surface. They should be willing to fix it," he said.

CMS instituted the HAC Reduction Program in fiscal year 2015, to reduce payments to the lowest-performing hospitals.

Of the 3,284 hospitals participating in the HAC program, 721, or 22 percent, were penalized, according to JAMA.

The JAMA authors created an eight-point hospital quality summary score using hospital characteristics related to volume, accreditations, and offering of advanced care services.

Hospitals with higher hospital quality summary scores had significantly better performance on nine of 10 publicly reported measures compared with hospitals that had lower quality scores, according to the study.

However, hospitals with the highest quality score were penalized more more often than hospitals with the lowest quality score, JAMA stated.

The study's data was obtained from CMS' Hospital Compare, the 2014 American Hospital Association Annual Survey and FY2015 Medicare Impact File.

The findings suggest CMS should reconsider how it assesses hospital penalties to ensure it is achieving the intended goal, the study's authors stated. They questioned whether the program accurately measures quality and fairly penalizes hospitals.

Twitter: @SusanMorseHFN