*Updated March 2023
Preventable hospital-acquired conditions (HACs) are a significant cost burden on the U.S. health system and are linked to poor patient care outcomes. The impact of HACs on patient safety and spending is especially serious among Medicare patients, who are more likely to experience HACs.
To address this, the Centers for Medicare and Medicaid Services (CMS) launched the HAC reduction program to improve patient safety and reduce common, but avoidable conditions that patients can contract during hospital stays. Under the mandatory program, CMS reduces overall Medicare payments for hospitals that rank in the worst-performing quartile of all hospitals on HAC measures.
Below, we highlight some key statistics you need to know about HACs.
1. Most common hospital-acquired conditions
CMS tracks various distinct conditions as part of its HAC Reduction Program including several healthcare-associated infections. These infections include:
- Central line-associated bloodstream infection (CLABSI)
- Catheter-associated urinary tract infection (CAUTI)
- Surgical site infection (SSI) for abdominal hysterectomy and colon procedures
- Methicillin-resistant staphylococcus aureus (MRSA) bacteremia
- Clostridium difficile Infection (CDF or C. diff)
CMS also tracks one composite measure of patient safety. This metric is based on falls, bed sores, and other conditions and events people may experience in a hospital. Below, we summarize the number of HACs by observed cases.
Number of HACs by observed cases
- CDF or C. diff: 43,387
- CAUTI: 18,175
- MRSA: 11,375
- SSI - Colon: 7,509
- SSI - Hysterectomy: 2,118
Fig 1 Data from Definitive Healthcare based on the CMS Quality Metrics Update, updated January 2023.
While some studies have revealed an overall drop in HAC rates in recent years, others found that these value-based programs – including the HAC Reduction Program – have failed to reduce HACs. Ultimately, HACs are still common in facilities across the U.S., leading to unnecessary spending and poor care outcomes. These outcomes include increased readmission rates and higher mortality rates. For example, researchers estimate that C.diff infections – one of the most common HACs – increases hospitalization-related costs by more than half and lengthens a patient’s hospital stay by 3.6 days, on average.
2. Hospitals with the highest HAC penalties
The Centers for Medicare and Medicaid Services (CMS) imposes financial penalties on hospitals that have high rates of preventable, hospital-acquired conditions (HACs). These HAC penalties are intended to incentivize hospitals to improve the quality of care they deliver and reduce HAC rates. However, our data on quality metrics show that many of the hospitals fined in fiscal year 2021 were the same hospitals fined in previous years.
CMS calculates HAC penalties using a hospital’s rate of HACs relative to other hospitals. Hospitals with rates that are significantly higher than the average face the largest financial penalties. Every year, hospitals in the lowest-performing 25% are penalized by losing 1% of their Medicare payments for the upcoming year. Opponents say this method artificially limits how many hospitals can succeed.
In fiscal year 2022, more than 700 hospitals faced the value-based penalty after seeing high patient infection and complication rates in 2018 and 2019. CMS excludes data from 2020 due to the COVID-19 pandemic.
Top hospitals by FY 2021 revenue loss related to HAC penalties
||Est. revenue loss due to HAC penalty
||NewYork-Presbyterian Weill Cornell Medical Center
||Cedars-Sinai Medical Center
||UCSF Helen Diller Medical Center at Parnassus Heights
||Stony Brook University Hospital
||Montefiore Hospital - Moses Campus
Fig 2 Data from Definitive Healthcare based on the CMS Quality Metrics Update, updated January 2023.
Not only do HACs cost hospitals money, but they also dramatically impact clinical outcomes. HAC penalties can be significant costs for hospitals, and they are often passed on to patients in the form of higher prices. In some cases, these added costs can put a strain on a patient’s finances and even lead to financial hardship.
3. Populations most susceptible to HACs
Because HACs have such a dramatic impact on a patient’s long-term health, CMS and other industry organizations are continually seeking the best methods to track and reduce their occurrence. In 2017, the American Hospital Association openly criticized the HAC Reduction Program for failing to recognize hospital improvement year over year. The program also came under fire for not considering patient demographics when evaluating individual facilities. Factors like employment, socioeconomic status, and insurance coverage all impact patient wellness and access to preventative care, which can affect the risk of developing a HAC.
States with the highest estimated revenue loss due to HAC penalties in 2021
- California: -$ 28,056,645
- New York: -$ 27,109,425
- Florida: -$ 14,327,124
- Texas: -$ 11,017,915
- New Jersey: -$ 10,422,786
Fig 3 Data from Definitive Healthcare based on the CMS Quality Metrics Update, updated March 2023.
California hospitals lost the greatest combined revenue due to HAC Reduction Program penalties in fiscal year 2021. This could be attributed to a variety of factors, including large populations of both urban and rural patients. Urban patients may be more susceptible to lapses in wellness due to being uninsured or underinsured or may be unable to access regular care due to economic factors. Rural patients could face barriers to healthcare such as lack of transportation and high care costs. New York, which ranked second by greatest revenue loss, would likely face similar population health issues, with providers juggling the distinct needs of urban and rural patients.
Definitive Healthcare’s Atlas Dataset integrates data from thousands of disparate sources to give you an unparalleled view of the healthcare market. To learn more about Definitive Healthcare’s quality of care data, including HAC scores, readmission and complication rates, and infection measures, start your free trial today.