Changes in Hospital-acquired Conditions and Mortality Associated With the Hospital-acquired Condition Reduction Program

Ann Surg. 2021 Oct 1;274(4):e301-e307. doi: 10.1097/SLA.0000000000003641.


Importance: To improve patient safety, the Centers for Medicare and Medicaid Services announced the Hospital-Acquired Condition Reduction Program (HACRP) in August 2013. The program reduces Medicare payments by 1% for hospitals in the lowest performance quartile related to hospital-acquired conditions. Performance measures are focused on perioperative care.

Objective: To evaluate changes in HACs and 30-day mortality after the announcement of the HACRP.

Design: Interrupted time-series design using Medicare Provider and Analysis Review (MEDPAR) claims data. We estimated models with linear splines to test for changes in HACs and 30-day mortality before the Affordable Care Act (ACA), after the ACA, and after the HACRP.

Setting: Fee-for-service Medicare 2009-2015.

Participants: Medicare beneficiaries undergoing surgery and discharged from an acute care hospital between January 2009 and August 2015 (N = 8,857,877).

Main outcome and measure: Changes in HACs and 30-day mortality after the announcement of the HACRP.

Results: Patients experienced HACs at a rate of 13.39 per 1000 discharges [95% confidence interval (CI), 13.10 to 13.68] in the pre-ACA period. This declined after the ACA was passed and declined further after the HACRP announcement [adjusted difference in annual slope, -1.34 (95% CI, -1.64 to -1.04)]. Adjusted 30-day mortality was 3.69 (95% CI, 3.64 to 3.74) in the pre-ACA period among patients receiving surgery. Thirty-day mortality continued to decline after the ACA [adjusted annual slope -0.04 (95% CI, -0.05 to -0.02)] but was flat after the HACRP [adjusted annual slope -0.01 (95% CI, -0.04 to 0.02)].

Conclusions and relevance: Although hospital-acquired conditions targeted under the HACRP declined at a greater rate after the program was announced, 30-day mortality was unchanged.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Aged
  • Aged, 80 and over
  • Fee-for-Service Plans / organization & administration*
  • Female
  • Health Policy
  • Hospital Mortality
  • Hospitalization
  • Humans
  • Iatrogenic Disease / epidemiology
  • Iatrogenic Disease / prevention & control*
  • Interrupted Time Series Analysis
  • Male
  • Medicare / organization & administration*
  • Quality Indicators, Health Care
  • United States