AAOS Now

Published 3/1/2016
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Julie B. Samora, MD, PhD, MPH; David B. Bumpass, MD

Decline in HACs Associated with Cost Savings and Fewer Deaths

Report suggests substantial progress being made
All too often, patients enter a hospital with one condition and acquire others during treatment. These hospital-acquired conditions (HACs), as defined by the Centers for Medicare & Medicaid Services (CMS), are common and costly medical complications that could reasonably have been prevented through the application of evidence-based guidelines.

The Deficit Reduction Act of 2005 attempted to address this issue by introducing payment policies to encourage hospitals to reduce the incidence of HACs. In essence, CMS would not reimburse for specific HACs. Today, the HAC payment policy covers 14 categories of HACs (Table 1), up from an initial list of 10 conditions.

Analyzing the data
In a recently published report by the Agency for Healthcare Research and Quality (AHRQ), the agency asserts that the program has had a significant impact on patient safety. The report states that the incidence of HACs nationwide has continuously declined since 2010. In fact, AHRQ estimates that the number of HACs declined by 17 percent from 2010 to 2014.

Per the report, 790,000 fewer incidents of harm occurred in 2014 than would otherwise have occurred if rates remained at 2010 levels. From 2011 through 2014, roughly 2.1 million fewer incidents of harm occurred. Approximately 40 percent of the improvements were from reducing the number of adverse drug events, 28 percent from reducing the incidence of pressure ulcers, and 16 percent from reducing catheter-associated urinary tract infections.

AHRQ contends that reductions in the rates of HACs saved more than 36,000 lives in 2014 and that 87,000 deaths have been prevented since HAC payment changes were implemented in 2010. In particular, reductions in pressure ulcer rates and adverse drug events were critical in preventing deaths. The agency also notes that the decline in HACs has resulted in estimated cumulative savings of $19.8 billion to the U.S. healthcare system (Fig. 1).

These statistics suggest that hospitals have made substantial progress in improving patient safety. The following factors have been cited as contributing to the decline in HACs:

  • financial incentives
  • public reporting
  • technical assistance offered to hospitals under the Quality Improvement Organization (QIO) program
  • Partnership for Patients (PfP) initiative under the Department of Health and Human Services

In 2014, CMS reorganized the QIO program. It created two Beneficiary and Family Centered QIOs, covering all 50 states and focused on addressing quality of care concerns and appeals. It also established 14 Quality Innovation Network-QIOs to work with providers, stakeholders, and Medicare beneficiaries to improve the quality of health care for targeted health conditions.

The PfP initiative is a public-private partnership that aims to improve the quality, safety, and affordability of health care. Its two main goals include making care safer and improving care transitions.

What's next?
Moving forward, AHRQ aims to broaden its efforts on quality improvement to include all healthcare settings, not just hospitals. With respect to specific conditions, AHRQ will focus on diagnostic error and antibiotic resistance. CMS is continuing its efforts to further improve patient safety as well. It recently announced the "Transforming Clinical Practices Initiative," which focuses on improving the quality of outpatient health care.

Although AHRQ has made inroads in improving patient care and continues to broaden its focus, the agency faces strong opposition from many members of Congress. The House Appropriations Committee has attempted to eliminate funding for AHRQ, contending that the agency is redundant and duplicates efforts of other divisions within the U.S. Department of Health and Human Services.

The medical literature includes some conflicting reports that question whether reducing HACs achieves real improvements in patient satisfaction. Moreover, the complications identified as HACs may not be the best measures to use in tracking hospital care quality. Continued explorations of the intricacies of the various kinds of HACs, regulatory programs, quality of care, and patient satisfaction are needed.

Julie B. Samora, MD, PhD, MPH, and David B. Bumpass, MD, are among the Washington Health Policy Fellows. Dr. Samora can be reached at julie.samora@nationwidechildrens.org and Dr. Bumpass can be reached at dbbumpass@uams.edu

References:

  1. Agency for Healthcare Quality and Research: Saving Lives and Saving Money: Hospital-acquired Conditions Update. Interim Data from National Efforts to Make Care Safer, 2010-2014. Publication #16-0009-EF. http://www.ahrq.gov/professionals/quality-patient-safety/pfp/interimhacrate2014.html Accessed December 14, 2015.
  2. Centers for Medicare & Medicaid Services: Hospital-Acquired Conditions. https://www.cms.gov/medicare/medicare-fee-for-service-payment/hospitalacqcond/hospital-acquired_conditions.html Accessed December 21, 2015.
  3. Day MS, Hutzler LH, Karia R, Vangsness K, Setia N, Bosco JA 3rd: Hospital-acquired conditions after orthopedic surgery do not affect patient satisfaction scores. J Healthc Qual 2014;36(6):33-40.
  4. Menendez ME, Ring D: Do hospital-acquired condition scores correlate with patients' perspectives of care? Qual Manag Health Care 2015;24(2):69-73.
  5. Mocanu V, Buth KJ, Johnston LB, Davis I, Hirsch GM, Légaré JF: The Importance of Continued Quality Improvement Efforts in Monitoring Hospital-Acquired Infection Rates: A Cardiac Surgery Experience. Ann Thorac Surg 2015;99(6):2061-2069.
  6. Rajaram R, Chung JW, Kinnier CV, et al: Hospital Characteristics Associated With Penalties in the Centers for Medicare & Medicaid Services Hospital-Acquired Condition Reduction Program. JAMA 2015;314(4):375-383.