Why Worry about HAC During a Pandemic?

Considering the burden of COVID-19 on hospitals, CMS implemented exceptions for the Hospital-Acquired Conditions (HAC) Reduction Program and the Hospital Value-Based Purchasing Program for the first half of 2020. Good, one less thing to worry about, right? True, by not collecting and submitting data, and having a period of time that will not count toward penalty this year a small piece of the current resource strain on hospitals has been lifted. At the same time, HAC outcomes should concern hospital leaders greatly during this crisis. A lapse in efforts to avoid HAC now could have detrimental consequences in many ways. Consider that now may be absolutely the Right Time to focus on eliminating HAC as the stakes are critical in means of being Right for Patients, Right for Hospital Peak Capacity Performance, and Right Financially.

Right for Patients

In the United States, the preventable harms labeled HAC still happen to nearly 1 in 10 hospitalized patients, contributing greatly to patient suffering and mortality (1). Hospital length of stay has been shown to increase significantly by around one day with HACs experienced in joint replacement and spinal surgery admissions (2) and 14 days with gastrointestinal procedures (3). In addition to physical suffering, extra time in the hospital adds to already pervasive feelings of isolation from normal social support systems during the pandemic. HACs also contribute to the financial burden of patients for their portion of treatment costs both while hospitalized and in the outpatient setting (4). In the current environment, these adverse effects on patients magnify as many of them face multiple financial hardships such as job loss, loss of health insurance, and/or high deductible plans. 

Right for Hospital Peak Capacity Performance

Hospitals presently experience unprecedented, extensive and extended strains on many parts of the system effecting performance outcomes. Of crucial importance, HACs have the potential to add to the current stressors on capacity and throughput by lengthening stay, as shown above, in ICU and overall. With bed and staff capacity pushing past normal limits and to their breaking point in some instances already, decreasing efficiency in throughput by having patients with a HAC in an ICU or other bed for 1-14 days longer (2, 3) than without a HAC further jeopardizes the ability of these limited resources to handle peak performance demand.

Right Financially

While hospitals may be off the hook for HAC data for the first six months of 2020, a shorter reporting period may not serve them well when it comes to being in the bottom quartile. Quarters of poor performance will take on greater weight with a smaller data set and make it harder to stay away from incurring the 1% penalty on CMS reimbursement. In addition, a meta-analysis performed by the Agency for Healthcare Research and Quality (AHRQ) estimates the average additional treatment costs for HAC at $31,000 per case (1). With revenue stream interrupted by lack of elective procedures and increased spending due to substantial COVID-19 related costs, who can afford to lose money to penalty and treatment costs of these preventable patient harms.

Now is the Right Time

Public reporting of performance may be on pause in some arenas, but it is not going away. Your scorecard performance may hold even more importance now and in the future. Patients and payers have been demanding transparency for decades and the current health care climate will only increase the need to find places with the best safety and quality outcomes if patients are going to risk having elective procedures. Stopping data collection, measurement, and accountability for the short term as a small relief could end up causing a loss of focus and jeopardize future results. As hospitals will not bear the COVID-19 burden equally, the CMS exemption period will help prevent undue impact on potential CMS penalty. Yet the risk of missing valuable learning opportunities from the data in avoiding HAC for the COVID-19 population exists and should be collected even if not included in the CMS programs. The stated goal of pausing CMS program data collection and reporting during this time is ensuring resource allocation to patient and staff health and safety. Avoiding HAC should be a key objective toward this end. In addition to being the right thing to do to avoid physical, emotional, and financial harm to patients, eliminating HACs will also boost hospital peak capacity performance, and financial outcomes during this pandemic. 

References 1.    Agency for Healthcare Research and Quality (2017). Estimating the Additional Hospital Inpatient Cost and Mortality Associated With Selected Hospital-Acquired Conditions. https://www.ahrq.gov/hai/pfp/haccost2017.html 2.    Horn, S. R., Liu, T. C., Horowitz, J. A., Oh, C., Bortz, C. A., Segreto, F. A., ... & Diebo, B. G. (2018). Clinical impact and economic burden of hospital-acquired conditions following common surgical procedures. Spine, 43(22), E1358-E1363. 3.    Moghadamyeghaneh, Z., Stamos, M. J., & Stewart, L. (2019). Patient Co-morbidity and functional status influence the occurrence of hospital acquired conditions more strongly than hospital factors. Journal of Gastrointestinal Surgery, 23(1), 163-172. 4.    Coomer, N. M., & Kandilov, A. M. (2016). Impact of hospital-acquired conditions on financial liabilities for Medicare patients. American journal of infection control, 44(11), 1326-1334.