Wednesday, July 29, 2015

JAMA Network | JAMA | Hospital Characteristics Associated With Penalties in the Centers for Medicare & Medicaid Services Hospital-Acquired Condition Reduction Program

Hospital Characteristics Associated With Penalties in the Centers for Medicare & Medicaid Services Hospital-Acquired Condition Reduction Program


Another paradoxical result becomes apparent impeaching the meaning of statistics in health care. Like the Propublica report on Surgeon grading, the findings of the HAC   Hospital Readmissons Programs reveal that 'better hospitals' (according to JCAH metrics) sometimes perform more poorly than under-rated hospitals. It points out that re-admission rates may be a meaningless benchmark to rate  hospitals. It may only serve to reduce Medicare reimbursements just for it's only purpose.

Main Outcomes and Measures  Hospital characteristics associated with penalization.
Results  Of the 3284 hospitals participating in the HAC program, 721 (22.0%) were penalized. Hospitals were more likely to be penalized if they were accredited by the Joint Commission (24.0% accredited, 14.4% not accredited; odds ratio [OR], 1.33; 95% CI, 1.04-1.70); they were major teaching hospitals (42.3%; OR, 1.58; 95% CI, 1.09-2.29) or very major teaching hospitals (62.2%; OR, 2.61; 95% CI, 1.55-4.39; vs nonteaching hospitals, 17.0%); they cared for more complex patient populations based on case mix index (quartile 4 vs quartile 1: 32.8% vs 12.1%; OR, 1.98; 95% CI, 1.44-2.71); or they were safety-net hospitals vs non–safety-net hospitals (28.3% vs 19.9%; OR, 1.36; 95% CI, 1.11-1.68).  Hospitals with the highest quality score of 8 were penalized significantly more frequently than hospitals with the lowest quality score of 0 (67.3% [37/55] vs 12.6% [53/422]; P < .001 for trend).

Conclusions and Relevance  Among hospitals participating in the HAC Reduction Program, hospitals that were penalized more frequently had more quality accreditations, offered advanced services, were major teaching institutions, and had better performance on other process and outcome measures. These paradoxical findings suggest that the approach for assessing hospital penalties in the HAC Reduction Program merits reconsideration to ensure it is achieving the intended goals.

Policy makers must reassess these programs and remove them if they do not stand the test of time.  Reductions of medicare reimbursement may penalize the wrong hospitals.


JAMA Network | JAMA | Hospital Characteristics Associated With Penalties in the Centers for Medicare & Medicaid Services Hospital-Acquired Condition Reduction Program
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