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In an effort to reduce the number of preventable illnesses and readmissions post-acute care, the Center for Medicare and Medicaid Services (CMS) launched the HAC Reduction Program as a means to incentivize hospitals to take stronger precautionary measures.

Development of HACs leads to increased healthcare spending, a higher risk of patient deaths and readmissions, longer length of stay, and other complications. CMS tracks 14 HACs across several categories, including surgical site infections, blood stream infections, and pressure ulcers. However, the HAC Reduction Program only takes 6 of these into account: Clostridium Difficile (C.Diff), Catheter-Associated Urinary Tract Infections (CAUTI), Central-Line-Associated Blood Stream Infections (CLABSI), Methicillin-resistant Staphylococcus aureus (MRSA), and Surgical Site Infections for colon surgeries and hysterectomies.

Starting in FY2018 The Winsorsized z-score methodology was implemented. to calculate HAC Total Score. With the Winsorization, the raw measure result of hospitals that fall below the 5th percentile and above the 95th percentile are set to the 5th and 95th percentile respectively. After this adjustment, the Winsorsized measure result is equal to the raw measure result. The scores displayed are determined by taking a hospital’s Winsorsized measure result subtracting the mean of Winsorsized measure results and dividing that result by the standard deviation of Winsorsized measure results.

With this calculation, a negative domain score indicates a better performance since it reflects measure values below (or better than) the national mean. Of the hospitals receiving the lowest scores for HAC Reduction Program, 6 of the top 50 are located in Texas — more than any other single state. Alabama had 5 on the list and Arkansas, Oklahoma, Pennsylvania, and Utah all had 3 hospitals on the list.

Coversely, for FY2019 more than 773 hospitals were fined for reporting excess cases of hospital-acquired conditions (HACs), losing a total of $258.4 million in revenue.

Top 50 Hospitals by HAC Score

  Hospital Name State Definitive ID HAC Total Score Est. Revenue Loss Due to HAC Penalty Net Patient Revenue

1.

Mayhill Hospital

TX

4855

-1.92

$0

$12,719,100

2.

St. Vincent’s Chilton

AL

868588

-1.92

$0

$16,356,812

3.

Indiana Orthopaedic Hospital

IN

1357

-1.87

$0

$165,674,223

4.

Kansas Surgery & Recovery Center

KS

1617

-1.87

$0

$41,864,366

5.

New England Baptist Hospital

MA

1971

-1.87

$0

$225,021,802

6.

OrthoNebraska Hospital

NE

2524

-1.87

$0

$80,351,192

7.

Orthopaedic and Spine Specialists Orthopaedic Hospital

PA

553368

-1.87

$0

$119,810,526

8.

Premier Surgical Institute

KS

776981

-1.87

$0

$28,855,180

9.

The Orthopedic Specialty Hospital

UT

4220

-1.87

$0

$96,828,964

10.

Jack Hughston Memorial Hospital

AL

106

-1.83

$0

$63,417,969

11.

Orthopaedic Hospital of Wisconsin

WI

4530

-1.82

$0

$72,890,848

12.

Midwest Orthopedic Specialty Hospital

WI

4532

-1.8

$0

$74,938,082

13.

Baylor Scott & White Orthopedic and Spine Hospital - Arlington

TX

552496

-1.77

$0

$108,929,468

14.

CHI St Lukes Health - Lakeside Hospital

TX

4095

-1.72

$0

$36,226,456

15.

Wiregrass Medical Center

AL

59

-1.72

$0

$19,891,706

16.

Smyth County Community Hospital

VA

4299

-1.71

$0

$47,384,792

17.

Wagoner Community Hospital

OK

3371

-1.71

$0

$24,137,244

18.

Straith Hospital for Special Surgery

MI

2060

-1.7

$0

$13,352,208

19.

Stilwell Memorial Hospital

OK

3251

-1.69

$0

$17,814,376

20.

AllianceHealth Clinton

OK

3280

-1.68

$0

$20,777,516

21.

Connally Memorial Medical Center

TX

4195

-1.68

$0

$32,754,267

22.

Jersey Community Hospital

IL

1193

-1.68

$0

$43,139,117

23.

Lakes Regional Healthcare

IA

1439

-1.68

$0

$39,645,044

24.

Regina Hospital

MN

2140

-1.68

$0

$59,599,356

25.

Samaritan Hospital - St Marys Campus

NY

2884

-1.68

$0

$77,082,939

26.

Crystal Clinic Orthopaedic Center

OH

3236

-1.67

$0

$160,470,401

27.

Healthmark Regional Medical Center

FL

932

-1.67

$0

$10,945,509

28.

Sevier Valley Hospital

UT

4230

-1.67

$0

$47,673,740

29.

Uintah Basin Medical Center

UT

4209

-1.67

$0

$78,139,611

30.

Atmore Community Hospital

AL

53

-1.66

$0

$17,062,699

31.

Banner Fort Collins Medical Center

CO

585468

-1.66

$0

$39,656,179

32.

Evergreen Medical Center

AL

41

-1.66

$0

$16,091,899

33.

Mena Regional Health System

AR

266

-1.66

$0

$26,778,469

34.

Northern Maine Medical Center

ME

1842

-1.66

$0

$50,125,396

35.

Northridge Medical Center

GA

1017

-1.66

$0

$20,139,218

36.

Oakdale Community Hospital

LA

1729

-1.66

$0

$12,551,998

37.

UPMC Susquehanna Sunbury

PA

3558

-1.66

$0

$16,005,016

38.

Ascension Seton Southwest

TX

4162

-1.65

$0

$26,258,327

39.

Baptist Health - Van Buren

AR

237

-1.65

$0

$19,125,843

40.

Cape Fear Valley - Hoke Hospital

NC

764460

-1.65

$0

$36,378,123

41.

Fleming County Hospital

KY

1661

-1.65

$0

$14,361,029

42.

Hill Regional Hospital

TX

4040

-1.65

$0

$21,223,714

43.

St James Hospital

NY

2902

-1.65

$0

$25,143,925

44.

Touchette Regional Hospital

IL

1256

-1.65

$0

$55,388,180

45.

UPMC Kane

PA

3538

-1.65

$0

$9,652,111

46.

AdventHealth Murray

GA

1034

-1.64

$0

$21,187,674

47.

Adventist Health Reedley

CA

324

-1.64

$0

$191,421,990

48.

Alliance Hospital

MS

2296

-1.64

$0

$9,009,301

49.

Astria Toppenish Hospital

WA

4417

-1.64

$0

$19,715,848

50.

Baptist Health Medical Center - Hot Spring County

AR

252

-1.64

$0

$23,774,707

Fig 1. Data is from the Centers for Medicare and Medicaid Services (CMS) Quality Metrics Update (October 2019). Next set of data is set to be updated in January 2020.