Problem: The purpose of this study was to better understand the relationship between repeated reimbursement penalties under the HACRP and improvement in hospital quality scores as well as the relationship between repeated penalties and hospital size and disproportionate share percentage.
Measurement: The primary metric for this study was change in the Total Hospital Acquired Condition (HAC) score after repeated penalties under the HACRP. Repeated penalties were defined as having received penalties under the program in FY2018 and FY2019. This metric was further stratified by hospital size and disproportionate share percentage.
Analysis: An independent t-test was utilized to identify a difference between Total HAC score of hospitals that received multiple penalties and those that did not as well as to detect differences between bed size (<100), medium (100-400), and large (>400). We used independent t-tests to further stratify by disproportionate share percentages.
Implementation: To identify the impact of repeated penalties on Total HAC score, we aggregated and analyzed databases available from Centers for Medicare and Medicaid Services (CMS). Our intention is that dissemination of these results generates discussion and further review of the structure of quality programs like the HACRP.
Results/Discussion: There is a positive relationship between multiple penalties and changes in Total HAC score. When splitting hospitals by bed size, effect size was largest among small hospitals and in hospitals that are not disproportionate share hospitals. Further analysis is needed to understand what else is impacting the Total HAC score.