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December 19, 2019

*Updated December 2019

Hospital-acquired conditions continue to cause excess healthcare spending and negatively impact patient care outcomes. In 2016, more than 3,219 patient deaths and $2 billion in excess spending resulted from avoidable hospital-acquired conditions (HACs), according to 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. 

Here are the key statistics you need to know about HACs as we head into 2020:

1. Most Common Hospital-Acquired Conditions

CMS tracks 14 distinct conditions as part of its HAC Reduction Program—an initiative designed to promote patient safety and reduce HAC episodes by penalizing those hospitals with the highest rates of hospital-acquired conditions. 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.

HACs by Number of Observed Cases

  1. C.Diff: 71,863
  2. CAUTI: 17,378
  3. CLABSI: 13,735
  4. MRSA: 8,108
  5. SSI - Colon: 7,805
  6. SSI - Hysterectomy: 2,119

Fig  Data from Definitive Healthcare based on the CMS Quality Metrics Update, updated December 2019.

The American Medical Association's Journal of Internal Medicine estimates that the current rates of C. Diff add an additional $1.5 billion annually to the cost of healthcare. 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. 

 

2. Hospitals with the Highest HAC Penalties

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.

Top 5 Hospital HAC Penalties in 2015

Rank Hospital Name Definitive ID Est. Revenue Loss Due to HAC Penalty
1. Yale New Haven Hospital 731 -$2,717,013
2. Barnes-Jewish Hospital 2442 -$2,140,381
3. Brigham and Women's Hospital 1969 -$2,082,695
4. Cleveland Clinic Main Campus 3120 -$1,967,804
5. North Shore University Hospital 2824 -$1,877,635

Top 5 Hospital HAC Penalties in 2018

Rank Hospital Name Definitive ID Est. Revenue Loss Due to HAC Penalty
1. Yale New Haven Hospital 731 -$2,877,816
2. Mount Sinai Medical Center 2837 -$2,379,489
3. NYU Langone Health Tisch Hospital 2843 -$2,240,566
4. Stanford Hospital 588 -$2,105,555
5. Montefiore Hospital - Moses Campus 273024 -$1,899,583

Fig 2 Trended HAC data from DHC Visuals, Definitive Healthcare's interactive analytic dashboards, using CMS quality reports from FY 2015 and FY 2018 YTD in December 2019.

Not only does continued HAC development cost hospitals money, it also dramatically impacts 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.

3. Populations Most Susceptible to HACs

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. In 2017, 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.

States with the Greatest Total Revenue Loss from HAC Penalties

  1. California: -$ 62,755,589
  2. New York: -$ 60,425,367
  3. Florida: -$ 31,264,451
  4. Pennsylvania: -$ 23,267,256
  5. Michigan: -$ 19,722,299

Fig 2 Data from Definitive Healthcare based on the CMS Quality Metrics Update, updated December 2019.

California 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. New York, 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.

Learn More 

Definitive Healthcare's platform provides a 360-degree view of over 7,939 hospitals in the U.S., helping users understand merger and acquisition activity, software and technology implementations, requests for proposals, certificates of need, affiliations, executive contact information, and detailed hospital financial, clinical, and quality metrics like HAC scores, and how they compare to state and national averages. To learn more about Definitive Healthcare's quality of care data, including HAC scores, readmission and complication rates, and infection measures, start your free trial today. 

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