Key result
Hospital penalization under the HACRP was not associated with significant changes in hospital acquired conditions (MD -0.16 per 1000 episodes; 95% CI -0.53 to 0.20), readmissions, or mortality.
Why the study?
To evaluate the association between hospital penalization under the US Hospital Acquired Condition Reduction Program and subsequent changes in clinical outcomes.
Does hospital receipt of a penalty in the HACRP reduce hospital acquired conditions, 30-day readmissions, or 30-day mortality in Medicare fee-for-service beneficiaries?
Cohort (n=15,470,334)
Yes
Does hospital receipt of a penalty in the HACRP reduce hospital acquired conditions, 30-day readmissions, or 30-day mortality in Medicare fee-for-service beneficiaries?
Mean Difference: -0.16 (95% CI -0.53–0.2)
Absolute Event Rate: 2.72% vs 2.06%
Hospital penalization under the HACRP was not associated with significant improvements in patient outcomes and may disproportionately penalize hospitals caring for disadvantaged patients.
HACRP penalization showed no outcome benefit; leaves open whether financial penalties effectively reduce hospital-acquired conditions.
OBJECTIVE: To evaluate the association between hospital penalization in the US Hospital Acquired Condition Reduction Program (HACRP) and subsequent changes in clinical outcomes. DESIGN: Regression discontinuity design applied to a retrospective cohort from inpatient Medicare claims. SETTING: 3238 acute care hospitals in the United States. PARTICIPANTS: Medicare fee-for-service beneficiaries discharged from acute care hospitals between 23 July 2014 and 30 November 2016 and eligible for at least one targeted hospital acquired condition (n=15 470 334). INTERVENTION: Hospital receipt of a penalty in the first year of the HACRP. MAIN OUTCOME MEASURES: Episode level count of targeted hospital acquired conditions per 1000 episodes, 30 day readmissions, and 30 day mortality. RESULTS: Of 724 hospitals penalized under the HACRP in fiscal year 2015, 708 were represented in the study. Mean counts of hospital acquired conditions were 2.72 per 1000 episodes for penalized hospitals and 2.06 per 1000 episodes for non-penalized hospitals; 30 day readmissions were 14.4% and 14.0%, respectively, and 30 day mortality was 9.0% for both hospital groups. Penalized hospitals were more likely to be large, teaching institutions, and have a greater share of patients with low socioeconomic status than non-penalized hospitals. HACRP penalties were associated with a non-significant change of -0.16 hospital acquired conditions per 1000 episodes (95% confidence interval -0.53 to 0.20), -0.36 percentage points in 30 day readmission (-1.06 to 0.33), and -0.04 percentage points in 30 day mortality (-0.59 to 0.52). No clear patterns of clinical improvement were observed across hospital characteristics. CONCLUSIONS: 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. By disproportionately penalizing hospitals caring for more disadvantaged patients, the HACRP could exacerbate inequities in care.
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Sankaran et al. (2019) conducted a cohort in Medicare fee-for-service beneficiaries eligible for targeted hospital acquired conditions (n=15,470,334). Hospital receipt of a penalty in the first year of the HACRP vs. Non-penalized hospitals was evaluated on Episode level count of targeted hospital acquired conditions per 1000 episodes (MD -0.16, 95% CI -0.53 to 0.20). Hospital penalization under the HACRP was not associated with significant changes in hospital acquired conditions (MD -0.16 per 1000 episodes; 95% CI -0.53 to 0.20), readmissions, or mortality.
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