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Hospital Penalties Do Not Drive Meaningful Improvements, May Worsen Inequities in Care: Study

Penalties charged against poor performing hospitals as part of a Medicare infection reduction program have not helped improve patient care, according to the findings of a new study, which suggests that the hospital penalties may exacerbate problems at facilities that generally treat disadvantaged patients.

University of Michigan researchers published a study last week in The BMJ, warning that a Medicare program that targets poor performing hospitals is not reducing common hospital-acquired infections, and may be worsening inequities in care.

Researchers evaluated hospital penalizations which are part of the U.S. Hospital Acquired Condition Reduction Program (HACRP) and subsequent changes in clinical outcomes among patients. HACRP is a Medicare implemented program focused on reducing hospital infections and deaths.

More than 3,000 acute care hospitals in the United States were included and compared to 700 hospitals penalized under HACRP in 2015. The study included data on more than 15 million Medicare patients discharged from acute care hospitals from July 23, 2014, to November 20, 2016.

According to the findings, penalized hospitals had more hospital acquired conditions among patients than non-penalized hospitals, with roughly three infections per 1,000 episodes; compared to only one for every 1,000 episodes in non-penalized hospitals.

Similarly, penalized hospitals had higher 30-day readmission rates. However, 30-day death rates were the same at both types of hospitals.

Non-penalized hospitals had fewer hospital acquired infections including central line-associated bloodstream infections, catheter-associated urinary tract infections, surgical site infections, methicillin-resistant staphylococcus aureus (MRSA) bacteremia, and Clostridium difficile infection.

Under HACRP, the worst performing 25% of Medicare hospitals receive a 1% payment reduction on all hospital claims. However, the researchers found that despite the risk of reduced payments and hospital revenue, the HACRP program did not help to decrease the number of hospital-acquired infections or the readmission rates.

Hospital Infections

Infections contracted while in the hospital are considered largely preventable using proper cleaning standards and medical care. However, hospital-acquired infections continue to be a problem in the U.S. healthcare system and cost more than $10 billion each year. The consequences of the infections can often be severe or even deadly.

Many hospital-acquired infections can be reduced by simple intervention measures, like disinfecting catheter caps or other practices like using sterile gloves or antimicrobial dressings increased infections should not be seen across hospitals.

Data from the new study indicates penalized hospitals are more likely to be large teaching hospitals and serve a higher proportion of patients from poor areas or low socioeconomic backgrounds.

“Penalization was not associated with significant changes in rates of hospital acquired conditions, 30 day readmission, or 30 day mortality, and does not appear to drive meaningful clinical improvements,” the researchers concluded. “By disproportionately penalizing hospitals caring for more disadvantaged patients, the HACRP could exacerbate inequities in care.”

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