Wednesday, December 30, 2015

A key AHRQ Health Care Metric - HAC rates down - but not so much lately and with some surprising laggards

AHRQ Data Show HAC Rate Continues To Decline in 2013 |
Agency for Healthcare Research & Quality
Hospital-Acquired Condition (HAC) Reduction Program - Centers for Medicare & Medicaid Services
 
HHS: EHRs, Financial Incentives Have Helped Increase Patient Safety As HACS Decline 17 Percent | Healthcare Informatics Magazine | Health IT | Information Technology
The widespread adoption of electronic health records (EHRs) has helped reduce hospital-acquired conditions by 17 percent over the past four years, resulting in 87,000 fewer patient deaths in 2014 alone, according to data collected by the Agency for Healthcare Research and Quality (AHRQ).
AHRQ, which operates under the U.S. Department of Health and Human Services, notes that hospitals have made “substantial progress in improving safety” and credits several likely contributing causes, including improved use of EHRs and financial incentives.
The AHRQ report states that hospital patients experienced 2.1 million fewer hospital-acquired conditions (HACs) from 2010 to 2014, which also saved the healthcare system approximately $19.8 billion in costs.
However, AHRQ data also indicates that after three years of declines in the number of avoidable HACs, that rate hit a plateau in 2014. Data shows that there were 145 HACS per 1,000 discharges in 2010 and that figure dropped to 121 per 1,000 discharges in 2013 and has held steady in 2014.


Hospital-acquired condition rates down but not as significant as first appears - FierceHealthcare
Efforts to reduce hospital-acquired conditions (HACs) have led to 87,000 fewer patient deaths and nearly $20 billion in healthcare cost savings over a four-year period, according to a new report released by the Department of Health and Human Services. But the findings may not be as significant as they seem.
Although federal officials lauded the findings from the Agency for Healthcare Research and Quality (AHRQ), patient safety experts interviewed by Kaiser Health News said that while hospitals have made progress, the preliminary 2014 data isn't as impressive as it may initially appear. Indeed the findings were similar to an AHRQ report released last month that showed hospital complications were 17 percent lower in 2013 than 2010. But the 17 percent decline is the same statistic cited in the latest report that includes 2014 data.
"We are still trying to understand all the factors involved, but I think the improvements we saw from 2010 to 2013 were very likely the low-hanging fruit, the easy problems to solve," Richard Kronick, Ph.D., director of the federal AHRQ, told KHN.

Nearly 800 hospitals receive penalties for poor hospital-acquired condition scores - FierceHealthcare
The Centers for Medicare & Medicaid Services will levy a 1 percent reimbursement penalty against nearly 800 hospitals due to poor performance on hospital-acquired conditions (HACs), the agency announced.
Of the 3,308 U.S. hospitals subject to Medicare's HAC program this year, 758 received the penalty compared to 724 last year. Only about half of the penalized providers were subject to the same penalty last year. The facilities in question stand to lose about $364 million in reimbursements.
However, the agency said hospital scores improved for central-line infections, but dropped for catheter-related urinary tract infections. CMS has also added new quality information to its Hospital Compare site, adding data on group practices and accountable care organizations, the agency said, as well as its first set of performance measures for individual practitioners on patient safety, cardiovascular care and patient safety.

Fiscal Year (FY) 2016 Results for the CMS Hospital-Acquired Conditions (HAC) Reduction Program
Public Reporting
On December 10, 2015, CMS made the following HAC Reduction Program information publicly available for each eligible hospital:
  • PSI 90 Composite measure score
  • CLABSI, CAUTI, and SSI measure scores
  • Domain 1 and Domain 2 scores
  • Total HAC Score
The FY2016 HAC Reduction Program scores for hospitals can be found on the Hospital Compare Website by following this link:
https://www.medicare.gov/hospitalcompare/HAC-reduction-program.html
The list of hospitals subject to the payment adjustments are posted on the following CMS.gov website under this link:
https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/HAC-Reduction-Program.html

Six local hospitals fined by Medicare for preventable infections | SanDiegoUnionTribune.com
Too many patients still acquire infections and other potentially deadly yet avoidable complications, the government’s latest review of quality-control efforts at hospitals across the country shows.
The problem plagues hospitals large and small, including prestigious medical centers with a reputation for top-flight care. For example, Scripps Green Hospital in La Jolla and UC San Diego Medical Center’s campuses in Hillcrest and La Jolla have infection scores that put them in the worst 5 percent of hospitals nationwide.
Infections and other hospital-acquired conditions are hardly a new challenge. But they are getting greater attention as part of health reforms rolled out with the Affordable Care Act, also known as Obamacare.
They are also part of a push by regulators to compel hospitals to scrutinize every aspect of their operations, including the most mundane tasks, so patients recover faster, get discharged promptly and receive proper follow-up treatment so they do not have to be readmitted.
Health officials and an assortment of independent ratings groups look at whether doctors and nurses are following nationally recommended standards of treatment. They assess whether hospitals are doing enough training and enforcement to minimize medication errors, preventable falls, bedsores, surgical mix-ups and the like. They also evaluate the continuum of care between a hospital and its affiliated physician groups.

Hospital-Acquired Conditions - Centers for Medicare & Medicaid Services
These 14 categories of HACs listed below include the new HACs from the IPPS FY 2013 Final Rule which are Surgical Site Infection Following Cardiac Implantable Electronic Device (CIED) and Iatrogenic Pneumothorax with Venous Catheterization.  For FY 2014and FY 2015, there are no additional HACs added:
  1. Foreign Object Retained After Surgery
  2. Air Embolism
  3. Blood Incompatibility
  4. Stage III and IV Pressure Ulcers
  5. Falls and Trauma: Fractures, Dislocations, Intracranial Injuries, Crushing Injuries, Burn, and Other Injuries
  6. Manifestations of Poor Glycemic Control: Diabetic Ketoacidosis, Nonketotic Hyperosmolar Coma, Hypoglycemic Coma, Secondary Diabetes with Ketoacidosis, Secondary Diabetes with Hyperosmolarity, 
  7. Catheter-Associated Urinary Tract Infection (UTI)
  8. Vascular Catheter-Associated Infection
  9. Surgical Site Infection, Mediastinitis, Following Coronary Artery Bypass Graft (CABG):
  10. Surgical Site Infection Following Bariatric Surgery for Obesity: Laparoscopic Gastric Bypass, Gastroenterostomy, Laparoscopic Gastric Restrictive Surgery
  11. Surgical Site Infection Following Certain Orthopedic Procedures: Spine, Neck, Shoulder, Elbow
  12. Surgical Site Infection Following Cardiac Implantable Electronic Device (CIED)
  13. Deep Vein Thrombosis (DVT)/Pulmonary Embolism (PE) Following Certain Orthopedic Procedures: Total Knee Replacement, Hip Replacement
  14. Iatrogenic Pneumothorax with Venous Catheterization

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