Medicare HAC Reduction Program

 Running head: MEDICARE HAC REDUCTION PROGRAM 1
Medicare HAC Reduction Program
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MEDICARE HAC REDUCTION PROGRAM 2
Medicare HAC Reduction Program
Introduction
Hospital-Acquired Condition Reduction Program (HAC) was initially created to take
1% of payments from those health care institutions, where patients have experienced injuries
and infections during their stay. This is a good way to make hospitals improve their
conditions and prevent patient sufferings. Unfortunately, a financial punishment seems to be
the most efficient way to make the hospitals understand their guilt and start taking measures
in order to make inpatient stay at the health care institutions beneficial for all clients.
The reason for the introduction of this program were the data, which have shown that
in 1999, the Institute of Medicine has caused death of 98,000 patients due to medical errors
and unacceptable hospital treatment methods (Wolters Kluwer Law and Business Health
Editorial, 2015, p. 870). The calculations revealed the astonishing truth. Eighteen types of
medical errors cost $9.3 billion in excess charges and resulted in 32,600 deaths. Severe
actions had to be taken in order to change the situation.
Framework and Scoring the HAC Program
Starting from the 1st of October, 2015, nearly 25% of hospitals will be involved in this
program. It presupposes that they will provide the prospective payment system with 1% of
their profits. The framework of the program is based on hospital performance. The evaluation
will take into account three quality measures, which include PSI-90 (patient safety indicator),
central line-associated blood stream infection and catheter-associated urinary tract infection
(Wolters Kluwer Law and Business Health Editorial, 2015, p. 871).
The process of scoring will be divided into two domains. The first domain will be
based on the PSI-90 indicator. Wolters Kluwer Law and Business Health Editorial provides
the detailed explanation of the factors, which will affect this rate. They will include:
“pressure ulcer rate, latrogenic pneumothorax rate, central venous catheter related blood 
MEDICARE HAC REDUCTION PROGRAM 3
stream infection rate, postoperative hip fracture rate, postoperative embolism, postoperative
sepsis rat, wound dehiscence rate, and finally accidental puncture and laceration rate” (p.
871). The second domain will include central line-associated blood stream infection and
catheter-associated urinary tract infection. The program presupposes that the first domain will
be accountable for 25% of the total score and the second domain – for 75% of the total score
(according to the HAC fact sheet). The data will be obtained from the Inpatient Standard
Analytic Files gathered from 2011 to 2013. The treatment of patients will be analyzed,
comparing it to the diagnosis. It will help to understand whether the adverse health
consequences were caused by individual human factors or by medical errors of the hospital
staff. The methodology applied for this problem resembles the one, which was used for the
HVB Purchasing Program. It means that there will be score gradation, from 1 to 10. The
evaluation of hospitals will be based on this scale.
Every domain includes its individual factors. Each hospital will be estimated in
accordance with them, and the total sum obtained in the end will be the total score of the
hospital. The top 25% of hospitals of the domain score will be punished according to the
regulations of this program.
The program also includes the part, which enables hospitals to review their score.
Every hospital will be provided with cost-reporting period. After its ending, medical
institutions will obtain the right for re-examination. Moreover, the class of hospital will be
primarily significant, as the payment established by the program will take it into account.
Basic Timelines of HAC Reduction Program Implementation
According to the fact sheet of the HAC Reduction Program, it is planned that 24-
month collection period will be applied to gather the data. In case of the first domain, the data
will be taken from July 2011 up to June 2013. In case of the second domain, the situation is
more complex. For the evaluation of the catheter-associated urinary tract infection and central 
MEDICARE HAC REDUCTION PROGRAM 4
line-associated blood stream infection, the temporal period from 2012 up to 2013 will be
chosen. For the analysis of surgical site infections, the period will be different; it will
encompass the term that started in 2013 and ended in 2014. For the estimation of the MRSA
infection, the data from the 2014-2015 collection periods will be analyzed; the same concerns
the evaluation of the clostridium difficile infection.
The official start of the program is also different for the domains. The payment for the
PSI-90 will take place starting from October 2015. It also concerns evaluation of the cathetera