Measurement matters: changing penalty calculations under the hospital acquired condition reduction program (HACRP) cost hospitals millions.
Measurement matters: changing penalty calculations under the hospital acquired condition reduction program (HACRP) cost hospitals millions.
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DOI：
10.1186/s12913-021-06108-w
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发表时间：
2021-02-10
影响因子：
2.8
通讯作者：
Waters TM
中科院分区：
文献类型：
--
作者：
Vsevolozhskaya OA;Manz KC;Zephyr PM;Waters TM
自2014年10月以来，医疗保险和医疗补助服务中心根据医院获得性疾病减少计划（HACRP）对25%的医院获得性疾病发生率最高的美国医院进行了处罚。虽然HACRP计划的早期评估报告了医院获得性疾病的累积减少，但最近的研究并没有发现接受HACRP惩罚与医院护理质量之间的明确联系。我们认为，一些这种脱节可能是由频繁的得分更新驱动的。HACRP处罚对项目评分方法更新的敏感性尚未得到独立评估。我们使用来自14个州的医院出院记录来评估HACRP评分方法的变化与相应的处罚状态变化之间的关系。为了隔离评分方法随时间变化的影响，我们使用2018财年医院绩效数据，使用2015财年至2018财年CMS评分方法计算HAC总分。根据不同的HACRP评分方法比较医院的处罚状况，我们发现，在使用2015财年和2016财年的评分方法（95%）以及2017财年和2018财年的方法（46%）时，被处罚的医院之间存在显著的重叠，但在早期和后期存在实质性差异。在所有四年中，只有15%的医院有资格受到处罚。我们还发现医院在不同年份的（相对）排名发生了显著变化，这表明处罚状况的变化不是由聚集在处罚阈值附近的HAC分数的微小变化驱动的。HACRP处罚对项目更新非常敏感，通常在绩效期结束后公布。这种绩效与处罚之间的脱节，令人质疑HACRP是否有能力按照预期提高患者安全。在线版本包含补充材料，可在（10.1186/s12913-021-06108-w）获得。
Since October 2014, the Centers for Medicare and Medicaid Services has penalized 25% of U.S. hospitals with the highest rates of hospital-acquired conditions under the Hospital Acquired Conditions Reduction Program (HACRP). While early evaluations of the HACRP program reported cumulative reductions in hospital-acquired conditions, more recent studies have not found a clear association between receipt of the HACRP penalty and hospital quality of care. We posit that some of this disconnect may be driven by frequent scoring updates. The sensitivity of the HACRP penalties to updates in the program’s scoring methodology has not been independently evaluated. We used hospital discharge records from 14 states to evaluate the association between changes in HACRP scoring methodology and corresponding shifts in penalty status. To isolate the impact of changes in scoring methods over time, we used FY2018 hospital performance data to calculate total HAC scores using FY2015 through FY2018 CMS scoring methodologies. Comparing hospital penalty status based on various HACRP scoring methodologies over time, we found a significant overlap between penalized hospitals when using FY 2015 and 2016 scoring methodologies (95%) and between FY 2017 and 2018 methodologies (46%), but substantial differences across early vs later years. Only 15% of hospitals were eligible for penalties across all four years. We also found significant changes in a hospital’s (relative) ranking across the various years, indicating that shifts in penalty status were not driven by small changes in HAC scores clustered around the penalty threshold. HACRP penalties have been highly sensitive to program updates, which are generally announced after performance periods are concluded. This disconnect between performance and penalties calls into question the ability of the HACRP to improve patient safety as intended. The online version contains supplementary material available at (10.1186/s12913-021-06108-w).
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