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In 2016, more than 3,219 patient deaths and $2 billion in excess spending resulted from avoidable hospital-acquired conditions (HACs), according to new research from IBM Watson Health. Despite guidelines and performance penalties from the Centers for Medicare and Medicaid Services (CMS), IBM documented more than 48,700 HACs that led to increased length of stays and higher mortality risk. We've pulled some statistics on HACs you should know heading into 2019.
When CMS launched the HAC Reduction Program for fiscal year 2015, the goal was to reduce preventable complications by fining the lowest-performing hospitals. If a hospital's performance was in the bottom 25 percent of all participating facilities, it would receive a 1 percent payment reduction from the Secretary of Health and Human Services.
The penalty should have encouraged hospitals to institute measures curbing these avoidable illnesses, but trended Definitive Healthcare data on quality metrics shows that many of the hospitals fined back in 2015 faced the same penalties in fiscal year 2018 -- including Yale New Haven Hospital, which paid the highest penalty both years.
Fig 1 Trended HAC data from DHC Visuals, Definitive Healthcare's interactive analytic dashboards, using CMS quality reports from FY 2015 and FY 2018 YTD.
Not only does continued HAC development cost hospitals money, it also dramatically affects clinical outcomes. The IBM Watson Health study found that, in 2016 alone, patients who contracted an HAC faced an average length of stay over 8 days longer than patients who did not experience an HAC. Additionally, the study revealed that HACs increase patient mortality risk by more than 72 percent.
Because HACs have such a dramatic impact on a patient's long-term health, CMS and other industry organizations are continually seeking the best methods to track and reduce their occurrence. Last year, the American Hospital Association openly criticized the HAC Reduction Program for failing to recognize hospital improvement year over year. The program also came under fire for not taking patient demographics into consideration when evaluating individual facilities. Factors like employment, socioeconomic status, and insurance coverage all impact patient wellness and access to preventative care, which can affect risk of developing an HAC.
Fig 2 Data from Definitive Healthcare based on the CMS Quality Metrics Update, updated Oct 2018.New York hospitals lost the greatest combined revenue due to HAC Reduction Program penalties in FY 2018. This could be attributed to a variety of factors, including large populations of both urban and rural patients. Urban patients could be made more susceptible to lapses in wellness due to being uninsured or underinsured, or may unable to access regular care due to economic factors. Rural patients could face barriers to healthcare such as lack of transportation and high care costs. California, which ranked second by greatest revenue loss, would likely face similar population health issues, with providers juggling the distinct needs of urban and rural patients.
CMS tracks 14 distinct HACs, including presence of foreign objects after surgery, catheter-associated infections, pressure ulcers, various surgical site infections, deep vein thrombosis, and more -- though only 6 are considered as part of the HAC Reduction Program. The conditions included in the program are: Clostridium Difficile (C.Diff), Catheter-Associated Urinary Tract Infections (CAUTI), Central-Line-Associated Blood Stream Infections (CLABSI), Methicillin-resistant Staphylococcus aureus (MRSA), and Surgical Site Infections for colon surgeries and hysterectomies.
Fig 3 Data from Definitive Healthcare based on the CMS Quality Metrics Update, updated Oct 2018.
Though the overall rate declined approximately 8 percent from 2014 to 2016, HACs are still prevalent in facilities across the U.S., leading to unnecessary spending and poor care outcomes such as increased readmission rates and higher mortality rates. To learn more about how understanding hospital quality metrics can impact your business, visit our blog.