The Hospital Acquired Conditions reduction program was
introduced four years back under the Affordable Care Act as a budgetary
motivation for hospitals to circumvent hospital-acquired conditions and
diseases, such as blood clots, central-line-associated bloodstream infections,
pressure sores, and various types of in-hospital injuries etc. Under the
program, a list is compiled using the HAC scoring methodology to rank hospitals
based upon their HAC performance. Hospitals that rank in the lowest quartile
score stand to face a 1% reduction in their total Medicare reimbursements for
the following fiscal year.
On 28th December 2017, the federal
government announced that it will reduce Medicare payments for 2018 to 751
different hospitals as a penalty for having the highest number of patient
injuries. The greater part of the facilities in this list were also punished in
the preceding year under the HAC Reductions Program and yet again they face a
1% reduction in their Medicare funding for the fiscal year 2018.
Teaching hospitals once more bore the brunt of the
penalty, although relatively less than last year. In 2017, half of the
penalties had been imposed on teaching hospitals but in 2018, only about
one-third of the names in the list are those of teaching hospitals, according
to a Kaiser Health News investigation.
The 115 punished educational institutions this year
include Indiana University Health North Hospital, Mercy St Vincent Medical
Center in Ohio, Denver Health Medical Center, The Mount Sinai Hospital in New
York City, Northwestern Memorial Hospital in Chicago, and University Of
Virginia Medical Center in Charlottesville, as indicated by federal accounts.
According to a written statement released by Stanford
Healthcare (one of the establishments implicated by the penalty), teaching
hospitals undertake a higher rate of patients with complicated conditions and as
a result those patients are naturally at a higher danger of contracting hospital
acquired infections (HAIs), as compared to community health care providers. “Hospitals
with a high rate of immunocompromised patients will always seem to have higher
HAIs”, the statement claimed.
The analysis conducted by Kaiser health group also
concluded that facilities that tend to substantial numbers of patients from low-income
groups were fined more than those facilities with a more prosperous patient
base. Such hospitals are referred to as a safety net health system, and they
provide a significant level of care to low-income, uninsured, and vulnerable
populations. About 33% of such safety-net hospitals were penalized in 2018,
about the same figure as the preceding year.
The penalty has sparked debate and controversy from
the start. The hospital industry claims it is an unjust punishment for those hospitals
that undertake treatment of sicker patients and those that identify infections
more effectively. However the patients argue that, while not impeccable, the
penalty has still been a significant push to urge hospital staff to think about
more than just turnover and revenues while dealing with and treating patients.
Dr. Kevin Kavanagh, board director of Health Watch USA
(a patient advocacy group) stated that the HAC Reduction Program has been exceptionally
crucial in forcing hospital staff to pay more attention to patient safety,
well-being, and enhanced quality. Despite this, he stated, the financial
vulnerability caused by the Republican attempts to renounce the Affordable Care
Act has made matters complicated.
He voiced his concerns about how at this moment it is
difficult for hospitals to enhance patient safety when there has been such a
great amount of disorder in the health care market and suggested that the hospitals
should make attempts to improve the situation, given that they possess the necessary
information and tools to do so.
Dr. Atul Grover, VP at the Association of American
Medical Colleges, said that while teaching hospitals as a whole performed
better relative to last year, they are still “disproportionately affected”.
In addition to this, the investigation also indicated
that 336 hospitals that lost their Medicare funding in 2017 were spared in
2018. They include Barnes Jewish Hospital in St. Louis, Brigham and Women’s
Hospital in Boston, Cedars-Sinai Medical Center in Los Angeles, the Cleveland
Clinic, and the University of Michigan Health System in Ann Arbor, to name a
Medicare penalized 425 facilities that it had also
imposed penalties on a year ago. For all the hospitals implicated in the list,
the diminishments will retroactively apply to Medicare installments from the
earliest starting point of the federal monetary year in October and through the
finish of September 2018. Medicare will cut by 1 percent its reimbursements for
every patient’s stay, and in addition the amount of money hospitals get in
order to spend on their teaching programs and to care for low-income
individuals. The resulting sum for every hospital thus relies upon the amount
they end up charging Medicare.
The factors considered in the Hospital Acquired
Condition Reduction Program criterion incorporate rates of Central
Line-Associated Bloodstream Infection (CLABSI), Catheter-Associated Urinary Tract
Infection (CAUTI), Surgical Site Infection (SSI), Methicillin-resistant Staphylococcus
aureus (MRSA) bacteremia, and Clostridium Difficile Infection (C-Diff). Medicare
likewise considers the recurrence of 10 kinds of in-hospital injuries and
wounds, including bed sores, hip fractures, blood clots, sepsis and
post-surgical ruptures. Such conditions are all termed under HACs and may be
avoided if proper care and attention be given to patient safety.
A few hospitals have been focusing on the diseases
that Medicare penalizes as well as advertises on its Hospital Compare site. One
such example is UCSF, which has been focusing on reducing surgical site contaminations
and C-diff cases. In a statement, UCSF announced that they stay focused on
persistently diminishing infection rates to give the most superior level of
care to our patients.
As a whole, the hospital industry is still disgruntled
with the fundamental model of this penalty, despite moves by the Centers for Medicare
and Medicaid Services to change its techniques for evaluating installments. Congress
declared that since Medicare imposes penalties on the worst performing quartile
of hospitals each year, whichever way you look at it, it still means that around
750 facilities will lose their funding each year regardless of whether or not
they had improved their records.
According to Nancy Foster, VP for quality and patient security
at the American Hospital Association, often the distinction between penalized
facilities and those that got away was very minute or insignificant. She
expressed how disappointing it is to realize that numerous hospitals wind up
getting a critical punishment when their conduct isn’t all that different to
other hospitals. “It’s a ‘HACidental’ payment policy,” she said.
A few categories of hospitals are immune to being
considered for penalties, such as centers that treat psychiatric patients,
veterans or children. In addition to this, facilities with the “basic
access” assignment for being the main healthcare provider in a specific
area are also exempted. Maryland clinics are barred from the program since
Medicare has a different technique for paying them.
The current political situation regarding the repeal
of the Affordable Care Act makes matters more chaotic for the hospital
industry, throwing everything up into limbo for the foreseeable future until it
has been finalized. Since years, Republicans have worn out Democrats for
supporting the ACA. In July of 2017, the Republican efforts to undo the Affordable
Care Act which have spanned around seven years, seemed to reach a dead-end in the
Senate, leaving President Trump promising to let President Barack Obama’s
signature domestic achievement crumble and fail. He claimed that his plan was
to “let Obamacare fail”, adding that it would be “a lot easier”. However, attempts
to end the health care law , especially in the absence of a new law to replace
it, were not successful at the time because they did not have sufficient
support in the senate.
It was evident that the Senate Republicans had not
been able to deliver a legislative policy that could keep everyone happy and
earn general support, as they could not formulate a health law that would
replace Obamacare, despite their criticism and attempts to abolish it.
More recently, the Senate Republicans have decided to
include the repeal of the Affordable Care Act’s requirement that most people
have health insurance into the tax rewrite, thereby combining the fight over
health care with the effort to cut taxes.
The senate republicans have also made a deliberate
move to help accelerate their bill to passage on a party-line vote: They
disclosed in November 2017 that they would set all of their tax cuts for
individuals to expire by 2025. Their deep cut in the corporate tax rate would
remain indefinite. Making sure individual provisions expire by 2025 helps lower
the overall cost of the bill, which can a maximum of $1.5 trillion to the
deficit over a period of 10 years.
The mandate repeal could mean that it would save 300$
billion over the course of 10 years but it would still cause 13 million
Americans not being covered by health insurance by the end of those 10 years,
potentially resulting in a health care crisis, according to the Congressional
Budget Office. Republicans claimed in November 2017 that they would utilize the
savings (which would arise from diminished government spending to subsidize
health coverage) to pay for an increase in the middle class tax cuts that has
been initially suggested.
The reduction in cooperation between the two parties
in recent year has resulted in an understandably difficult situation,
oftentimes ending in a stalemate and no conclusive decisions being taken as