HAC 2020: The State of the State of California

As we reflect on progress made in the 10 years since the Patient Protection and Affordable Care Act (ACA) mandated improvements to patient safety and quality, I would like to focus in one one area of particular concern, keeping patients safe from events that should never happen in hospitals. These serious infections and complications called HAC or Hospital-Acquired Conditions include: central line associated blood stream infections, catheter associated urinary tract infections, adverse drug events, falls, clostridium difficile infections, surgical site infections, ventilator associated pneumonia, venous thromboembolism, obstetric adverse events, and pressure ulcers. While the data can be sliced and diced in countless ways, one fact far outweighs any other: We have not made much of a dent in this problem. These preventable harms still happen to nearly 1 in 10 hospitalized patients, contributing greatly to patient suffering and mortality, and wasteful healthcare spending with average additional, non-reimbursable treatment costs at $31,000 per case (Agency for Healthcare Research and Quality, 2017).

The 2020 Hospital Compare data from the U.S. Centers for Medicare and Medicaid Services Hospital-Acquired Condition Reduction Program portion of Value-Based Purchasing reveals insight into the state of our state. Let's look at the most pressing data point for hospital executives and administrators: Who will be penalized this year for performing in the bottom quartile nationally. Of 295 reporting hospitals in the state of California, 96 (32.5%) will lose 1% of all federal reimbursement for 2020. The estimated amount penalized for these California hospitals adds up to over $51 million with the average loss per hospital above $500,000 ($2,048 - $3,517,599). Of these 96 hospitals, 65 also fell into the bottom quartile in 2019 (Advisory Board, 2020).

Let's pause a minute to consider the most obvious implications. One third of California's hospitals currently fall into the bottom 25% in the country when it comes to keeping patients safe from events that should Never Happen. Not good news for patients in California or for our basic belief that in caring for people we should first Do No Harm. With our hospitals and especially ICUs currently strained with the burden of COVID-19 every case of HAC further compromises patient recovery and clogs throughput of an ICU bed opening up for the next person needing this limited, specialized level of care. With tight operating margins and costs escalating, most hospitals could desperately use the dollars being lost to CMS penalty and non-reimbursable treatment costs for countless needed improvements and personnel. Poor performance seems to be a difficult cycle to break despite best efforts as two thirds of hospitals continue to perform in the bottom bracket despite previous year penalty.

We need to begin using different tactics than we have thus far in order to make meaningful improvements in the next 10 years. Through research with top performing hospitals, our team at Top Performance Improvement provides the missing pieces and solutions designed to end this cycle of patient harm and financial loss.

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Estimating the Additional Hospital Inpatient Cost and Mortality Associated With Selected Hospital-Acquired Conditions. Content last reviewed November 2017. Agency for Healthcare Research and Quality, Rockville, MD. https://www.ahrq.gov/hai/pfp/haccost2017.html

Hospital-Acquired Condition Reduction Program. U.S Centers for Medicare and Medicaid Services, https://www.medicare.gov/hospitalcompare/HAC-reduction-program.html

Map: The 786 hospitals facing HAC penalties in 2020. Feb. 3, 2020. Advisory Board. https://www.advisory.com/daily-briefing/2020/02/03/hac-penalties