25 hospitals with the greatest revenue loss from HAC penalties

In efforts to reduce the number of preventable illnesses and readmissions after a patient leaves the hospital, the Centers for Medicare and Medicaid Services (CMS) launched the Hospital-Acquired Condition (HAC) Reduction Program to incentivize hospitals to take stronger precautionary measures.

Ensuring that patients face fewer complications during their inpatient hospital stay helps lower the risk of death, decrease lengths of stay, and control healthcare costs. The HAC reduction program reduces Medicare reimbursement for the worst-performing hospitals.

Using data from the Definitive Healthcare HospitalView product, we review hospitals by their estimated revenue loss due to HAC penalties for 2021. This proprietary calculation uses CMS sourced Medicare and quality data to approximate a dollar amount related to HAC penalties. About 775 hospitals received HAC penalties in 2021 and about 765 will face penalties in 2022.

Top hospitals with the highest HAC penalty revenue loss

Rank	Definitive ID	Hospital name	Location	HAC FY2021 total score	Estimated revenue loss	Number of discharges
1	541974	NewYork-Presbyterian Weill Cornell Medical Center	New York, NY	0.78	$4,043,719	102,654
2	430	Cedars-Sinai Medical Center	Los Angeles, CA	0.61	$3,138,689	50,098
3	560	UCSF Helen Diller Medical Center at Parnassus Heights	San Francisco, CA	0.58	$2,134,066	33,309
4	274110	UK Albert B. Chandler Hospital	Lexington, KY	0.41	$1,983,509	35,897
5	273024	Montefiore Hospital - Moses Campus	Bronx, NY	1.3	$1,859,209	73,728
6	2915	Stony Brook University Hospital	Stony Brook, NY	0.61	$1,732,451	37,984
7	2066	Beaumont Hospital - Royal Oak	Royal Oak, MI	0.59	$1,650,237	45,700
8	754	MedStar Washington Hospital Center	Washington, DC	0.42	$1,625,541	28,857
9	3742	Vanderbilt University Medical Center	Nashville, TN	0.34	$1,611,425	60,138
10	1940	Baystate Medical Center	Springfield, MA	0.46	$1,610,180	38,519
11	3019	ECU Health Medical Center	Greenville, NC	0.83	$1,598,955	39,794
12	1135	Northwestern Memorial Hospital	Chicago, IL	0.49	$1,561,746	41,891
13	1970	Beth Israel Deaconess Medical Center	Boston, MA	0.65	$1,535,578	37,590
14	3817	Baptist Memorial Hospital - Memphis	Memphis, TN	0.45	$1,521,987	32,992
15	2645	Hackensack University Medical Center	Hackensack, NJ	0.38	$1,502,814	40,402
16	3572	Thomas Jefferson University Hospital	Philadelphia, PA	0.52	$1,491,751	37,807
17	1927	Charlton Memorial Hospital	Fall River, MA	0.54	$1,490,526	29,364
18	1631	The University of Kansas Hospital	Kansas City, KS	0.52	$1,469,832	42,037
19	3439	UPMC Presbyterian	Pittsburgh, PA	0.42	$1,353,763	43,190
20	3140	Ohio State University Wexner Medical Center	Columbus, OH	0.43	$1,274,200	48,902
21	2803	Maimonides Medical Center	Brooklyn, NY	0.81	$1,266,625	32,048
22	274155	UofL Health - Jewish Hospital	Louisville, KY	0.63	$1,266,215	24,132
23	2035	Spectrum Health Butterworth Hospital	Grand Rapids, MI	0.54	$1,260,153	61,681
24	3055	Sanford Broadway Medical Center	Fargo, ND	0.75	$1,260,116	26,070
25	4534	Aurora St Luke's Medical Center of Aurora Health Care Metro	Milwaukee, WI	0.50	$1,254,963	32,981

Fig 1 Data from Definitive Healthcare HospitalView product. Quality measures are sourced from the Centers for Medicare and Medicaid Services (CMS) and updated annually. Data accessed October 2022.

Which hospital has the highest HAC penalty revenue loss?

NewYork-Presbyterian Weill Cornell Medical Center has the highest estimated revenue loss from HAC penalties at about $4 million. Cedars-Sinai Medical Center’s estimate HAC revenue loss is $3.1 million.

Of the hospitals facing the highest fines from the HAC Reduction Program, four of the top 25 are located in New York and three are in Massachusetts.

Four of the top five hospitals on the list are also some of the largest hospitals in the U.S. based on net patient revenue, including some of the top hospitals in the cities of New York City, Los Angeles, Chicago, Washington, DC, and Philadelphia. These hospitals serve large patient populations and have high patient discharge volumes, which likely contribute to their HAC scores and penalties.

How much revenue is lost to HAC penalties?

For fiscal year 2021, more than 773 hospitals faced HAC penalties for a total of $254 million in estimated lost revenue. The average revenue loss due to HAC penalties is about $328,800.

The top 25 hospitals that faced the largest penalties lost nearly $43 million, or about $1.7 million each.

What are hospital acquired conditions (HACs)?

The HAC Reduction Program is a value-based care program that links Medicare payments to inpatient quality. The hospitals that rank in the lowest quartiles of HAC performance face payment reductions.

The specific healthcare-associated infections tracked as part of the program include:

Clostridium Difficile (C.Diff)
Catheter-Associated Urinary Tract Infections (CAUTI)
Central-Line-Associated Blood Stream Infections (CLABSI)
Methicillin-resistant Staphylococcus aureus (MRSA)
Surgical Site Infections for abdominal hysterectomies and colon surgeries

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