Are Teaching Hospitals Treated Fairly in the Hospital-Acquired Condition Reduction Program?

Acad Med. 2018 Dec;93(12):1827-1832. doi: 10.1097/ACM.0000000000002399.


Purpose: To identify the factors associated with total Hospital-Acquired Condition Reduction Program (HACRP) score and with receiving a Centers for Medicare and Medicaid Services (CMS) penalty (1% reduction in payment to those hospitals in the lowest-performing quartile of HACRP scores) for fiscal years (FYs) 2015-2017 with a particular focus on trends over this period.

Method: The authors evaluated the following variables: (1) type of hospital (teaching vs. nonteaching); (2) disproportionate patient percentage; (3) case mix index (CMI); (4) number of staffed beds; (5) length of stay (LOS); (6) gross patient revenue; and (7) region, using data from CMS and the American Hospital Directory. They conducted multivariate linear and logistic regressions.

Results: A total of 2,249 hospitals were included. The mean total HACRP scores across hospitals for FY15, FY16, and FY17 were 5.38, 5.35, and 5.18, respectively. In FY15, 21.2% (476/2,249) of hospitals received a penalty compared with 22.6% (508/2,249) in FY16 and 31.3% (704/2,249) in FY17 (P < .001). The logistic regression model showed that teaching hospitals, larger hospitals (> 400 beds), hospitals with high CMI or long LOS, and hospitals in the Northeast and Western United States were more likely to receive a penalty. Teaching hospitals and larger hospitals did not improve their scores over time compared with nonteaching and small hospitals.

Conclusions: A reevaluation of the scoring methodology for the HACRP is needed. CMS could stratify hospitals into homogeneous categories and apply penalties to those that have the worst scores in each category.

MeSH terms

  • Aged
  • Centers for Medicare and Medicaid Services, U.S. / organization & administration*
  • Female
  • Hospitals, Teaching / organization & administration
  • Hospitals, Teaching / statistics & numerical data*
  • Humans
  • Iatrogenic Disease*
  • Length of Stay
  • Logistic Models
  • Male
  • Mandatory Programs / organization & administration
  • Mandatory Programs / statistics & numerical data*
  • Program Evaluation
  • Quality Indicators, Health Care / organization & administration
  • Quality Indicators, Health Care / statistics & numerical data*
  • United States