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Study: Complication Rates, Hospital Size, and Bias in the CMS Hospital-Acquired Condition Reduction Program

A study published in the American Journal of Medical Quality investigated the possible link between complication rates, hospital size and bias in the CMS Hospital-Acquired Condition Reduction Program  (HAC-RP). In 2016, Medicare’s HAC-RP will reduce hospital payments by $364 million. Although observers have questioned the validity of certain HAC-RP measures, less attention has been paid to the determination of low-performing hospitals (bottom quartile) and the assignment of penalties. This study investigated possible bias in the HAC-RP by simulating hospitals’ likelihood of being in the worst-performing quartile for 8 patient safety measures, assuming identical expected complication rates across hospitals. Simulated likelihood of being a poor performer varied with hospital size. This relationship depended on the measure’s complication rate. For 3 of 8 measures examined, the equal-quality simulation identified poor performers similarly to empirical data (c-statistic approximately 0.7 or higher) and explained most of the variation in empirical performance by size (Efron’s R2 > 0.85). The Centers for Medicare & Medicaid Services could address potential bias in the HAC-RP by stratifying by hospital size or using a broader “all-harm” measure.

Read more: Complication Rates, Hospital Size, and Bias in the CMS Hospital-Acquired Condition Reduction Program. American Journal of Medical Quality.